Healthcare Provider Details

I. General information

NPI: 1124342001
Provider Name (Legal Business Name): IVORY SHAE HOWELL LPCC, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: IVORY SHAE CARTER LPCC

II. Dates (important events)

Enumeration Date: 03/21/2010
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W 3RD ST SUITE 304
OWENSBORO KY
42303-4135
US

IV. Provider business mailing address

100 W 3RD ST SUITE 304
OWENSBORO KY
42303-4135
US

V. Phone/Fax

Practice location:
  • Phone: 270-302-1669
  • Fax: 270-698-9778
Mailing address:
  • Phone: 270-302-1669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number99128083A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number104689
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: