Provider Demographics
NPI:1245060888
Name:OAK AND IVY THERAPY SERVICES
Entity type:Organization
Organization Name:OAK AND IVY THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CCTP, CLC, MED
Authorized Official - Phone:206-823-7829
Mailing Address - Street 1:6063 S ACHERON AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-6191
Mailing Address - Country:US
Mailing Address - Phone:206-823-7829
Mailing Address - Fax:
Practice Address - Street 1:6063 S ACHERON AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-6191
Practice Address - Country:US
Practice Address - Phone:206-823-7829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health