Individual
ALPHONSO IVY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PLPC
Contact information
Practice address
1323 SULLIVAN AVE, SAINT LOUIS, MO 63107-3919
(314) 503-1746
(314) 488-2059
Mailing address
1323 SULLIVAN AVE, SAINT LOUIS, MO 63107-3919
(314) 503-1746
(314) 488-2059
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2016012675
MO
Other
Enumeration date
05/02/2016
Last updated
05/02/2016
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