Provider Demographics
NPI:1215330410
Name:JEFFRIES, IVY Y (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:IVY
Middle Name:Y
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 292965
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37229-2965
Mailing Address - Country:US
Mailing Address - Phone:615-319-4793
Mailing Address - Fax:615-712-7279
Practice Address - Street 1:1916 PATTERSON ST
Practice Address - Street 2:SUITE 502
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2120
Practice Address - Country:US
Practice Address - Phone:615-319-4793
Practice Address - Fax:615-712-7279
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC2869101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional