Healthcare Provider Details

I. General information

NPI: 1023353075
Provider Name (Legal Business Name): JOCELYN IVY LPC-MHSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2012
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2455 SUTHERLAND AVE
KNOXVILLE TN
37919
US

IV. Provider business mailing address

201 W SPRINGDALE AVE
KNOXVILLE TN
37917-5158
US

V. Phone/Fax

Practice location:
  • Phone: 865-637-9711
  • Fax:
Mailing address:
  • Phone: 865-637-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3806
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: