MEDICARE: JAMI LANE IVEY LCSW, LADAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	1586	KY
2	1041C0700X	Clinical Social Worker	6162	TN
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1083797211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMI LANE IVEY LCSW, LADAC

Provider Business Mailing Address
First Line	:	808 SHERRILL ST
Second Line	:
City	:	UNION CITY
State	:	TN
Zip	:	38261-5854
Country	:	US
Telephone Number	:	270-887-8744
Fax Number	:

Provider Business Practice Location Address
First Line	:	808 SHERRILL ST
Second Line	:
City	:	UNION CITY
State	:	TN
Zip	:	38261-5854
Country	:	US
Telephone Number	:	270-887-8744
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	10/10/2025

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