Provider Demographics
NPI:1154338820
Name:IVEY, DAVID C (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:IVEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:CHARLES
Other - Last Name:IVEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:5502 58TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-2087
Mailing Address - Country:US
Mailing Address - Phone:806-797-3020
Mailing Address - Fax:806-792-1506
Practice Address - Street 1:5502 58TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-2000
Practice Address - Country:US
Practice Address - Phone:806-797-3020
Practice Address - Fax:806-792-1506
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25097103T00000X
TX3012106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX036353301Medicaid
TX036353301Medicaid