Individual provider Active NPI

Irene Gomez, MA, LMHC

  • Mental Health Counselor
  • Anthony, NM
National Provider Identifier
1114568656
Registry record updated Oct 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
CTL0204661 Issued in NM
Practice address
785 Anthony Drive
Anthony, NM 88021-2671
Phone
(575) 882-5100
Fax
(575) 882-1151
NPI assigned
Oct 7, 2019
Sex
Female
Sole proprietor
No

Organizations & group practices 5

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.

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Evizzit of Iowa Psychiatry PC 52 clinicians

Practice addresses (Care Compare)

1501 42ND St
Suite 575
West Des Moines, IA 50266-1060
Phone (855) 270-3625

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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

Enrollment IDStateProvider typePAC IDDetails
I20231215001171 IA Practitioner - Mental Health Counselor 3971632902 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
CTL0204661NMMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Amanecer Community Counseling Center CurrentSince Oct 13, 2019 Accepting new patients
Evizzit of Iowa Psychiatry PC CurrentSince Jan 1, 2024 Accepting new patients
Counseling Las Cruces, LLC Past Accepting new patients
Evizzit of Iowa Psychiatry PC PastSince Dec 26, 2021 Accepting new patients
Amanecer Community Counseling Center, LLC PastSince Oct 13, 2019 Accepting new patients

Locations

1501 42nd St
Ste 120
West Des Moines, IA 50266

1501 42nd St
Ste 575
West Des Moines, IA 50266
Phone 8552703625171

785 Anthony Dr
Anthony, NM 88021
Phone (575) 882-5100

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X CTL0204661 NM Primary

Addresses

NPPES NPI Registry

Primary practice location

785 Anthony Drive
Anthony, NM 88021-2671

Mailing address

PO Box 2671
Anthony, NM 88021-2671
Phone (575) 882-5100

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
35650338MedicaidNM

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 7, 2019.

{
    "created_epoch": "1570406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570406400000",
    "number": "1114568656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2671",
            "city": "ANTHONY",
            "state": "NM",
            "postal_code": "880212671",
            "telephone_number": "575-882-5100",
            "fax_number": "575-882-1151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "785 ANTHONY DRIVE",
            "city": "ANTHONY",
            "state": "NM",
            "postal_code": "880212671",
            "telephone_number": "575-882-5100",
            "fax_number": "575-882-1151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMEZ",
        "first_name": "IRENE",
        "credential": "MA, LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-07",
        "last_updated": "2019-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NM",
            "license": "CTL0204661",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "35650338",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anthony, NM

Sources for this page

Verify at the official NPI Registry.