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General NPI Number Information
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NPI Number | 1851165252
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Entity Type | Organization
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Legal Business Name | IVY MENTAL HEALTH, PLLC
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Dates
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Enumeration Date | 11/07/2023
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 16336 124TH PL NE
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City | WOODINVILLE
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State | WA
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Zip | 98072-7995
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Country | US
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Telephone | 425-298-3238
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Fax |
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Provider Business Mailing Address
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Address Line | 14241 NE WOODINVILLE DUVALL RD
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City | WOODINVILLE
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State | WA
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Zip | 98072-8564
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Country | US
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Telephone | 425-298-3238
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Fax |
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH THERAPIST
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Name | IVYANNE JELLIBEAN VAN DER PEET
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Credential | LMHC
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Telephone | 425-298-3238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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