Charles L Diviney III, MC, LPC, NCC, CCMHC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

340426-6004 Issued in UT

Practice address

352 Denver St
Suite 215
Salt Lake City, UT 84111-3000

Phone

(801) 521-4227

Fax

(801) 359-0777

NPI assigned

Apr 19, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Charles L Diviney III MC LPC NCC LLC

  • Professional Counselor
  • SLC, UT
  • NPI 1235447772
  NPD

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278460800000",
    "number": "1174588230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3872",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841103872",
            "telephone_number": "801-201-4096",
            "fax_number": "801-521-4227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "352 DENVER ST",
            "address_2": "SUITE 215",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841113000",
            "telephone_number": "801-521-4227",
            "fax_number": "801-359-0777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIVINEY",
        "first_name": "CHARLES",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "MC, LPC, NCC, CCMHC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-19",
        "last_updated": "2010-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "UT",
            "license": "340426-6004",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "UT",
            "license": "340426-6004",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": "340426-6004",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "34042660001001",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anna Tedie Disera
• Dana Whitney Dishman, PHARMD, MPS
• Brianna Jae Dissler, OD
• Kaitlyn Ditty
• Savannah Divin
• Division of Nephrology University of Utah
• Division of Occupational Therapy University of Utah
• Abagayle Layne Dixon
• Adria Ann Dixon, SPEECH LANGUAGE PATH
• Barbara Leatherman Dixon, RDH, BS, MED

• Professional Counselor in Salt Lake City, UT
• Providers in Salt Lake City, 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 7, 2010; 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.