Individual
TRELESS IVEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
439 SW MICHIGAN ST, LAKE CITY, FL 32025-0440
(352) 374-5600
Mailing address
PO BOX 51, LIVE OAK, FL 32064-0051
(386) 438-4537
Taxonomy
Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
06/05/2014
Last updated
06/05/2014
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