Provider Demographics
NPI:1760949077
Name:IVY, BEVERLY YVONNE
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:YVONNE
Last Name:IVY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BEVERLY
Other - Middle Name:YVONNE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1990 ROYAL BLVD
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-2529
Mailing Address - Country:US
Mailing Address - Phone:630-788-9037
Mailing Address - Fax:
Practice Address - Street 1:1475 ROYAL BLVD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-2040
Practice Address - Country:US
Practice Address - Phone:847-531-8420
Practice Address - Fax:847-531-6242
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health