Provider Demographics
NPI:1508183096
Name:KATZ, IVY MEREDITH (MA, LPC)
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:MEREDITH
Last Name:KATZ
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4333 SE 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3317
Mailing Address - Country:US
Mailing Address - Phone:503-729-5790
Mailing Address - Fax:
Practice Address - Street 1:2305 SE 50TH AVE # 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-3853
Practice Address - Country:US
Practice Address - Phone:503-505-1270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4280101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional