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NPI Code Detail

MEDICARE: TERQUESE IVORY MS, CMHP, QMHP, QUDP

MEDICARE: TERQUESE IVORY MS, CMHP, QMHP, QUDP
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1629602321
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERQUESE IVORY MS, CMHP, QMHP, QUDP
Provider Business Mailing Address
First Line : 1040 W BRISTOL RD
Second Line :
City : FLINT
State : MI
Zip : 48507-5516
Country : US
Telephone Number : 810-516-7553
Fax Number :
Provider Business Practice Location Address
First Line : 1040 W BRISTOL RD
Second Line :
City : FLINT
State : MI
Zip : 48507-5516
Country : US
Telephone Number : 810-424-6027
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2020
Last Update Date : 06/15/2026

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