Provider Demographics
NPI:1346733227
Name:IVEY, ELLEN RENEE (LMSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:RENEE
Last Name:IVEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 S MONROE ST STE 205
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-2469
Mailing Address - Country:US
Mailing Address - Phone:734-240-3850
Mailing Address - Fax:
Practice Address - Street 1:25 S MONROE ST STE 205
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-2469
Practice Address - Country:US
Practice Address - Phone:734-240-3850
Practice Address - Fax:734-240-3863
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010916411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical