Provider Demographics
NPI:1659837573
Name:IVEY, RAMON LAWRENCE (LMFT)
Entity Type:Individual
Prefix:MR
First Name:RAMON
Middle Name:LAWRENCE
Last Name:IVEY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 DOVE ST STE 140
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3034
Mailing Address - Country:US
Mailing Address - Phone:714-588-1443
Mailing Address - Fax:
Practice Address - Street 1:901 DOVE ST STE 140
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-3034
Practice Address - Country:US
Practice Address - Phone:714-588-1443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT47717106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist