Provider Demographics
NPI:1336638162
Name:IVES, HOWARD ROLLIN
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:ROLLIN
Last Name:IVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 NEVIS CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-2560
Mailing Address - Country:US
Mailing Address - Phone:916-538-6744
Mailing Address - Fax:
Practice Address - Street 1:1295 NEVIS CT
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-2560
Practice Address - Country:US
Practice Address - Phone:916-538-6744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1890-PY-PR103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling