Provider Demographics
NPI:1346756384
Name:ARES, IVELISSE (RBT)
Entity Type:Individual
Prefix:
First Name:IVELISSE
Middle Name:
Last Name:ARES
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:IVELISSE
Other - Middle Name:
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:703 ELLIE NAT DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5595
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:703 ELLIE NAT DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5595
Practice Address - Country:US
Practice Address - Phone:931-551-1948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician