Theresa M. Ivey, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2023044583 Issued in MO

Practice address

860 Lynn St
Lebanon, MO 65536-3810

Phone

(844) 853-8937

NPI assigned

Apr 4, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Delta Health Services LLC

  • Mental Health Counselor
  • Sulphur, LA
  • NPI 1871193649
  Medicare reassignment NPD
• Fairway Counseling Agency, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Alexandria, LA
  • NPI 1912281031
  NPD (past)
• Mental Connections of Southwest LLC

  • Mental Health Counselor
  • Lake Charles, LA
  • NPI 1508301037
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1459728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713744000000",
    "number": "1457714628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 COMMUNITY",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647358804",
            "telephone_number": "844-853-8937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "860 LYNN ST",
            "city": "LEBANON",
            "state": "MO",
            "postal_code": "655363810",
            "telephone_number": "844-853-8937"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1112 Nolan Trce Ste B",
            "address_purpose": "LOCATION",
            "city": "Leesville",
            "state": "LA",
            "postal_code": "714463838",
            "country_code": "US",
            "telephone_number": "337-404-7731",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "710 Versailles Blvd",
            "address_purpose": "LOCATION",
            "city": "Alexandria",
            "state": "LA",
            "postal_code": "713032351",
            "country_code": "US",
            "telephone_number": "318-449-4474",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3683 S First St",
            "address_purpose": "LOCATION",
            "city": "Jena",
            "state": "LA",
            "postal_code": "713426409",
            "country_code": "US",
            "telephone_number": "318-992-2263",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1202 Kirkman St Ste C",
            "address_purpose": "LOCATION",
            "city": "Lake Charles",
            "state": "LA",
            "postal_code": "706015391",
            "country_code": "US",
            "telephone_number": "337-990-5305",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IVEY",
        "first_name": "THERESA",
        "middle_name": "M.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-04",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "LA",
            "license": "11372",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2023044583",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1457714628",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Integrity Home Care, LLC
• Integrity Home Care, LLC
• Intrepid U.S.a., Inc
• Sofia Iqbal, MD
• Mary E Isaacs, M.S.
• Jeannie Ann James, LPC
• Craig P Jay, RPH
• Chara Leigh Jensen, PT
• Joe'S Pharmacy Inc
• Daniel L. Johnson, FNP

• Clinical Social Worker in Lebanon, MO
• Providers in Lebanon, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.