Healthcare Provider Details

I. General information

NPI: 1508183096
Provider Name (Legal Business Name): IVY MEREDITH KATZ M.A, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22018 S CENTRAL POINT RD
CANBY OR
97013-8705
US

IV. Provider business mailing address

4333 SE 35TH AVE
PORTLAND OR
97202-3317
US

V. Phone/Fax

Practice location:
  • Phone: 503-221-4531
  • Fax: 866-485-6741
Mailing address:
  • Phone: 503-729-5790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC4280
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: