Provider Demographics
NPI:1902637747
Name:DENHARTOG, IVA ELIZABERTH (LPC)
Entity type:Individual
Prefix:MRS
First Name:IVA
Middle Name:ELIZABERTH
Last Name:DENHARTOG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:IVA
Other - Middle Name:ELIZABETH
Other - Last Name:LOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 PRAIRIE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-5385
Mailing Address - Country:US
Mailing Address - Phone:817-666-3068
Mailing Address - Fax:
Practice Address - Street 1:121 PRAIRIE AVE STE C
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-5385
Practice Address - Country:US
Practice Address - Phone:817-666-3068
Practice Address - Fax:817-648-3776
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84387101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional