| Ivy League Counseling Llc | |
|
1407 Highland Rd Roswell NM 88201-2146 | |
| (575) 840-9653 | |
| Not Available |
| Full Name | Ivy League Counseling Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1407 Highland Rd, Roswell, New Mexico |
| Authorized Official Name and Position | Chuck Ivy (OWNER) |
| Authorized Official Contact | 5758409653 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ivy League Counseling Llc 1407 Highland Rd Roswell NM 88201-2146 Ph: () - | Ivy League Counseling Llc 1407 Highland Rd Roswell NM 88201-2146 Ph: (575) 840-9653 |
| NPI Number | 1982286308 |
|---|---|
| Provider Enumeration Date | 04/26/2021 |
| Last Update Date | 04/26/2021 |
| Certification Date | 04/26/2021 |
| Medicare PECOS PAC ID | 7618386558 |
|---|---|
| Medicare Enrollment ID | O20210506000705 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982286308 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
| Provider Name | Chuck Ivy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134447386 PECOS PAC ID: 0244591477 Enrollment ID: I20180302000325 |
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