1124342001 NPI number — IVORY SHAE HOWELL LPCC, LMHC

Table of content: IVORY SHAE HOWELL LPCC, LMHC (NPI 1124342001)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124342001 NPI number — IVORY SHAE HOWELL LPCC, LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOWELL
Provider First Name:
IVORY
Provider Middle Name:
SHAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPCC, LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARTER
Provider Other First Name:
IVORY
Provider Other Middle Name:
SHAE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPCC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124342001
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 W 3RD ST
Provider Second Line Business Mailing Address:
SUITE 304
Provider Business Mailing Address City Name:
OWENSBORO
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42303-4135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-302-1669
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 W 3RD ST
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42303-4135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-302-1669
Provider Business Practice Location Address Fax Number:
270-698-9778
Provider Enumeration Date:
03/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  104689 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: 99128083A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 99128083A . This is a "INDIANA PROFESSIONAL LICENSING AGENCY BEHAVIORAL HEALTH AND HUMAN SERVICES BOARD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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