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NPI Code Detail

MEDICARE: DR. LAURIE C IVEY PSYD

MEDICARE: DR. LAURIE C IVEY PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist2584CO
2103TC0700XClinical PsychologistPSY.0002584CO

General Provider Information

NPI Number : 1063471811
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAURIE C IVEY PSYD
Provider Business Mailing Address
First Line : PO BOX 110429
Second Line :
City : AURORA
State : CO
Zip : 80042-0429
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1890 N REVERE CT
Second Line :
City : AURORA
State : CO
Zip : 80045-7464
Country : US
Telephone Number : 720-848-0000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2006
Last Update Date : 09/07/2022

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