Provider Demographics
NPI:1578198248
Name:IVINS, THOMSON (LPC)
Entity Type:Individual
Prefix:
First Name:THOMSON
Middle Name:
Last Name:IVINS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11807 AMYFORD BND
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-5370
Mailing Address - Country:US
Mailing Address - Phone:832-515-5257
Mailing Address - Fax:
Practice Address - Street 1:11807 AMYFORD BND
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5370
Practice Address - Country:US
Practice Address - Phone:832-515-5257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84042101YM0800X
FLIMH18786101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84042OtherLICENSED PROFESSIONAL COUNSELOR