Provider Demographics
NPI:1295213171
Name:IVY PSYCHOTHERAPIES LLC
Entity type:Organization
Organization Name:IVY PSYCHOTHERAPIES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:H
Authorized Official - Last Name:ALVIM-TOLD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-730-7789
Mailing Address - Street 1:2340 W 1620 N CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-5313
Mailing Address - Country:US
Mailing Address - Phone:917-730-7789
Mailing Address - Fax:970-367-1499
Practice Address - Street 1:580 PERSHING ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-3053
Practice Address - Country:US
Practice Address - Phone:917-730-7789
Practice Address - Fax:970-367-1499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-01
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99236371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO52720586Medicaid