Provider Demographics
NPI:1215325188
Name:BAHENA, IVONNE (LBSW)
Entity type:Individual
Prefix:MRS
First Name:IVONNE
Middle Name:
Last Name:BAHENA
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:MISS
Other - First Name:IVONNE
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LBSW
Mailing Address - Street 1:11023 HOLLY HILL LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-5400
Mailing Address - Country:US
Mailing Address - Phone:936-615-7800
Mailing Address - Fax:
Practice Address - Street 1:11023 HOLLY HILL LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77041-5400
Practice Address - Country:US
Practice Address - Phone:936-615-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51988104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker