Provider Demographics
NPI:1538635768
Name:IVY LEAF COUNSELING SERVICES
Entity Type:Organization
Organization Name:IVY LEAF COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:229-506-3136
Mailing Address - Street 1:10921 HERITAGE CIR N
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-8015
Mailing Address - Country:US
Mailing Address - Phone:229-506-3136
Mailing Address - Fax:
Practice Address - Street 1:578 AZALEA RD STE 112
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-1551
Practice Address - Country:US
Practice Address - Phone:251-300-8930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health