Provider Demographics
NPI:1588802268
Name:IVEY, JULIE (LMSW,, LCDC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:IVEY
Suffix:
Gender:F
Credentials:LMSW,, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24891 HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:TX
Mailing Address - Zip Code:77445-7747
Mailing Address - Country:US
Mailing Address - Phone:800-869-8552
Mailing Address - Fax:713-869-8564
Practice Address - Street 1:24891 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:TX
Practice Address - Zip Code:77445-7747
Practice Address - Country:US
Practice Address - Phone:800-869-8552
Practice Address - Fax:713-869-8564
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7745101YA0400X
TX32529104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)