Provider Demographics
NPI:1619322104
Name:JAMI IVEY, PC
Entity Type:Organization
Organization Name:JAMI IVEY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:IVEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:270-887-8744
Mailing Address - Street 1:1609 JULIE ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-5925
Mailing Address - Country:US
Mailing Address - Phone:270-887-8744
Mailing Address - Fax:
Practice Address - Street 1:1609 JULIE ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-6013
Practice Address - Country:US
Practice Address - Phone:270-887-8744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1202101YA0400X
KY0805101YA0400X
TN61621041C0700X
KY15861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100391890Medicaid
TN1031802928Medicare NSC