Provider Demographics
NPI:1780716795
Name:IVRA, BILLIE FAYE (PHD)
Entity type:Individual
Prefix:DR
First Name:BILLIE
Middle Name:FAYE
Last Name:IVRA
Suffix:
Gender:F
Credentials:PHD
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Other - First Name:
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Mailing Address - Street 1:4929 WILSHIRE BLVD 510
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3820
Mailing Address - Country:US
Mailing Address - Phone:562-904-3999
Mailing Address - Fax:855-688-8746
Practice Address - Street 1:4211 AVALON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-5622
Practice Address - Country:US
Practice Address - Phone:323-432-5185
Practice Address - Fax:323-432-5086
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA18055103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical