Provider Demographics
NPI:1902043664
Name:MAYHORN, IVORY JR
Entity Type:Individual
Prefix:MR
First Name:IVORY
Middle Name:
Last Name:MAYHORN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LAUNCHPOINT
Other - Middle Name:CDC
Other - Last Name:INC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5409 VAN ZANDT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77016-1828
Mailing Address - Country:US
Mailing Address - Phone:281-541-9776
Mailing Address - Fax:
Practice Address - Street 1:5409 VAN ZANDT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77016-1828
Practice Address - Country:US
Practice Address - Phone:281-541-9776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101Y00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst