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General NPI Number Information
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NPI Number | 1154338820
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Entity Type | Individual
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Provider Name | DAVID C. IVEY PH.D.
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Gender | Male
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 03/01/2012
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Provider Practice Location Address
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Address Line | 5502 58TH ST SUITE 600
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City | LUBBOCK
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State | TX
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Zip | 79414-2000
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Country | US
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Telephone | 806-797-3020
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Fax | 806-792-1506
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Provider Business Mailing Address
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Address Line | 5502 58TH ST SUITE 600
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City | LUBBOCK
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State | TX
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Zip | 79414-2087
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Country | US
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Telephone | 806-797-3020
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Fax | 806-792-1506
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 25097
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 3012
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License Number State | TX
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