MEDICARE: ALEXANDER IVORY

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	101YP2500X	Professional Counselor	6451022758	MI

General Provider Information

NPI Number	:	1386161883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER IVORY

Provider Business Mailing Address
First Line	:	23077 GREENFIELD RD., STE. 455
Second Line	:	PMB 1031
City	:	SOUTHFIELD
State	:	MI
Zip	:	48075
Country	:	US
Telephone Number	:	248-973-7646
Fax Number	:

Provider Business Practice Location Address
First Line	:	6639 CENTURION DR STE 130
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48917-8273
Country	:	US
Telephone Number	:	517-322-3050
Fax Number	:

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

Provider Enumeration Date	:	08/24/2017
Last Update Date	:	02/07/2025

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Directions to “ ALEXANDER IVORY ” Practice Location

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