Healthcare Provider Details

I. General information

NPI: 1093303752
Provider Name (Legal Business Name): IVY S LOHFF ASSOCIATE MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IVY S GROVER ASSOCIATE MFT

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 ALAMEDA DEL PRADO STE 201
NOVATO CA
94949-6698
US

IV. Provider business mailing address

2900 SAINT PAUL DR APT 112
SANTA ROSA CA
95405-8521
US

V. Phone/Fax

Practice location:
  • Phone: 415-457-6964
  • Fax:
Mailing address:
  • Phone: 909-973-9741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number116424
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: