Provider Demographics
NPI:1730726134
Name:IVEY, HEATHER SUZANNE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:SUZANNE
Last Name:IVEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6009 FINANCIAL PLZ # 105
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-2615
Mailing Address - Country:US
Mailing Address - Phone:318-670-8858
Mailing Address - Fax:
Practice Address - Street 1:6009 FINANCIAL PLZ # 105
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-2615
Practice Address - Country:US
Practice Address - Phone:318-670-8858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor