Ivy E. Assenberg, LPC
Individual provider Active NPI Professional Counselor · Jackson, WY
NPI 1760635940 · NPPES record last updated Feb 26, 2020
Key facts
- NPI
- 1760635940
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- LPC-420 (WY)
- Practice address
- 640 East Broadway
Jackson, WY 83001-1868 - Phone
- (307) 733-2046
- Fax
- (307) 733-6289
- NPI assigned
- Oct 31, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC-420 | WY | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mental Health & Recovery Services of Jackson Hole | Past |
Accepting new patients | |
| Mental Health & Recovery Services of Jackson Hole | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC-420 | WY | Yes |
Addresses
Primary practice location
640 East Broadway
Jackson, WY 83001-1868
Mailing address
PO Box 1868
640 East Broadway
Jackson, WY 83001-1868
Phone (307) 733-2046
Other providers in Jackson, WY
- Angus Goetz DO PC
- Cynthia L Archer
- Allison Odato Armitage
- Stephen Louis Arnold
- Deidre Ashley
- Megan Rose Avery
- Olga Baeva Johnson
- Pamela E Bailey
- Paul Bailey
- Sharon L Bailey
All providers in Jackson, WY · Professional Counselor in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.