Provider Demographics
NPI:1629083308
Name:IVEY, NATALIE L (LPC)
Entity Type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:L
Last Name:IVEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N 5TH ST
Mailing Address - Street 2:STE 505
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2627
Mailing Address - Country:US
Mailing Address - Phone:970-245-7489
Mailing Address - Fax:970-245-8014
Practice Address - Street 1:225 N 5TH ST
Practice Address - Street 2:STE 505
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2627
Practice Address - Country:US
Practice Address - Phone:970-245-7489
Practice Address - Fax:970-245-8014
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1123101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO116128Medicaid