Organization
THERESA M IVEY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA IVEY LCSW (OWNER)
(337) 377-3011
Entity
Organization
Contact information
Practice address
133 JEFFERSON DR, LAKE CHARLES, LA 70605-5713
(337) 377-3011
Mailing address
133 JEFFERSON DR, LAKE CHARLES, LA 70605-5713
(337) 377-3011
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
11372
LA
Other
Enumeration date
03/09/2018
Last updated
03/09/2018
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