Provider Demographics
NPI:1679268106
Name:IVIE, CHRISTINE M (LPC - 815)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:IVIE
Suffix:
Gender:F
Credentials:LPC - 815
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:M
Other - Last Name:IVIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SUPERINTENDENT
Mailing Address - Street 1:41 NORTHRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:ID
Mailing Address - Zip Code:83338-6200
Mailing Address - Country:US
Mailing Address - Phone:208-871-7749
Mailing Address - Fax:
Practice Address - Street 1:41 NORTHRIDGE WAY
Practice Address - Street 2:
Practice Address - City:JEROME
Practice Address - State:ID
Practice Address - Zip Code:83338-6200
Practice Address - Country:US
Practice Address - Phone:208-871-7749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-815101Y00000X
101YM0800X, 101YS0200X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool