Provider Demographics
NPI:1225447758
Name:O'ROURKE-KLEINKNECHT, IVORY ELOISE
Entity type:Individual
Prefix:
First Name:IVORY
Middle Name:ELOISE
Last Name:O'ROURKE-KLEINKNECHT
Suffix:
Gender:
Credentials:
Other - Prefix:DR
Other - First Name:IVORY
Other - Middle Name:
Other - Last Name:O'ROURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1333 S MAYFLOWER AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-5239
Mailing Address - Country:US
Mailing Address - Phone:828-228-8970
Mailing Address - Fax:
Practice Address - Street 1:15501 WESTON PKWY STE 130
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8641
Practice Address - Country:US
Practice Address - Phone:855-295-3276
Practice Address - Fax:888-588-2752
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6083103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6758Medicaid
CA7420Medicaid
CA7068Medicaid