Provider Demographics
NPI:1265407621
Name:IVEY, JAMEY LYNN (LCPC)
Entity type:Individual
Prefix:
First Name:JAMEY
Middle Name:LYNN
Last Name:IVEY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:JAMEY
Other - Middle Name:LYNN
Other - Last Name:DOMBROSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:FORT SHAW
Mailing Address - State:MT
Mailing Address - Zip Code:59443-0032
Mailing Address - Country:US
Mailing Address - Phone:406-264-5214
Mailing Address - Fax:
Practice Address - Street 1:915 1ST AVE S
Practice Address - Street 2:CENTER FOR MENTAL HEALTH
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3705
Practice Address - Country:US
Practice Address - Phone:406-791-9533
Practice Address - Fax:406-761-2107
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1194 LCPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000742250OtherBLUE CROSS/SHIELD OF MONT