Provider Demographics
NPI:1720648793
Name:IVYSEEDS PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:IVYSEEDS PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERIFF
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:866-489-7333
Mailing Address - Street 1:2517 MERLIN DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-5701
Mailing Address - Country:US
Mailing Address - Phone:510-501-7898
Mailing Address - Fax:
Practice Address - Street 1:6371 PRESTON RD STE 120
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-9297
Practice Address - Country:US
Practice Address - Phone:866-489-7333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty