Organization
IVY COUNSELING & WELLNESS SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. IVY DESIRAE BENNETT SIAS LPC (OWNER)
(310) 429-5025
Entity
Organization
Contact information
Practice address
326 SAINT MATTHIAS DR, CARENCRO, LA 70520-5576
(310) 429-5025
Mailing address
326 SAINT MATTHIAS DR, CARENCRO, LA 70520-5576
(310) 429-5025
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
12/04/2017
Last updated
12/04/2017
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