Mary Jean Iverson, CPCI

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6085774-6009 Issued in UT

Practice address

237 26TH Street
Ogden, UT 84401-3105

Phone

(801) 625-3605

Fax

(801) 625-3615

NPI assigned

Oct 30, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mary Jean Stark Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Weber Human Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Ogden, UT
  • NPI 1043243140
  NPD (past)

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

{
    "created_epoch": "1162166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073699302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "237 26TH STREET",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844013105",
            "telephone_number": "801-625-3605",
            "fax_number": "801-625-3615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "237 26TH STREET",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844013105",
            "telephone_number": "801-625-3605",
            "fax_number": "801-625-3615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVERSON",
        "first_name": "MARY",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "CPCI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "UT",
            "license": "6085774-6009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "STARK",
            "middle_name": "JEAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Marcella Israel Rocha, MD
• Melissa Arlene Ita'Aehau, PT
• Ashlee Ito
• Michael Travis Ivan, DO
• Clint G. Iverson, D.M.D.
• Richard Blaine Iverson, D.O.
• Jessica Ivy
• Kyle Jackman, D.O
• Angela Maria Jackson, LPC
• Matthew Jackson, PA-C, MPAS

• Professional Counselor in Ogden, UT
• Providers in Ogden, UT by specialty
• Professional Counselor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.