Provider Demographics
NPI:1407556004
Name:IVYMED BEHAVIORAL HEALTH PLLC
Entity Type:Organization
Organization Name:IVYMED BEHAVIORAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:IVY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:844-688-4866
Mailing Address - Street 1:700 CENTRAL EXPY S STE 400
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-8113
Mailing Address - Country:US
Mailing Address - Phone:844-688-4866
Mailing Address - Fax:844-688-4878
Practice Address - Street 1:700 CENTRAL EXPY S STE 400
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-8113
Practice Address - Country:US
Practice Address - Phone:844-688-4866
Practice Address - Fax:844-688-4878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-03
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health