Healthcare Provider Details

I. General information

NPI: 1588802268
Provider Name (Legal Business Name): JULIE IVEY LMSW,, LCDC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 02/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24891 HIGHWAY 6
HEMPSTEAD TX
77445-7747
US

IV. Provider business mailing address

24891 HIGHWAY 6
HEMPSTEAD TX
77445-7747
US

V. Phone/Fax

Practice location:
  • Phone: 800-869-8552
  • Fax: 713-869-8564
Mailing address:
  • Phone: 800-869-8552
  • Fax: 713-869-8564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number7745
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number32529
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: