Deedra Ivie, LPC
Individual provider Active NPI Professional Counselor · Brixey, MO
NPI 1912353145 · NPPES record last updated Apr 9, 2026
Key facts
- NPI
- 1912353145
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 0005775 (CO)
- Practice address
- 91 Verbena LN
Brixey, MO 65618-7802 - Phone
- (970) 231-7251
- NPI assigned
- May 6, 2016
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2008
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
66 E Flagler St
Miami, FL 33130-1807
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MO, CO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260331002699 | MO | Practitioner - Mental Health Counselor | 2365927076 | Reassigns benefits to 1 organization |
| I20260402001092 | CO | Practitioner - Mental Health Counselor | 2365927076 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0005775 | CO | MD | Professional Counselor |
| CC7342 | ME | MD | Professional Counselor |
| 2022006994 | MO | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2022006994 | MO | |
| Professional Counselor | 101YP2500X | 0005775 | CO | Yes |
| Professional Counselor | 101YP2500X | CC7342 | ME |
Addresses
Primary practice location
91 Verbena LN
Brixey, MO 65618-7802
Mailing address
PO Box 482
Gainesville, MO 65655-0482
Phone (970) 231-7251
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 9, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.