1902637747 NPI number — MRS. IVA ELIZABERTH DENHARTOG LPC

Table of content: MRS. IVA ELIZABERTH DENHARTOG LPC (NPI 1902637747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902637747 NPI number — MRS. IVA ELIZABERTH DENHARTOG LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DENHARTOG
Provider First Name:
IVA
Provider Middle Name:
ELIZABERTH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOTT
Provider Other First Name:
IVA
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902637747
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
121 PRAIRIE AVE STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEBURNE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76033-5385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-666-3068
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 PRAIRIE AVE STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEBURNE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76033-5385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-666-3068
Provider Business Practice Location Address Fax Number:
817-648-3776
Provider Enumeration Date:
08/13/2024

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:  84387 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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