Provider Demographics
NPI:1942812920
Name:CAMPOS, IVY (LMHC)
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3275 SW 143RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6594
Mailing Address - Country:US
Mailing Address - Phone:305-338-0429
Mailing Address - Fax:
Practice Address - Street 1:2103 CORAL WAY STE 405
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-2630
Practice Address - Country:US
Practice Address - Phone:305-445-9554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18245101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty