Ivy Mare Phoenix, CMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

11772649-6004 Issued in UT

Practice address

2965 W 3500 S
West Valley City, UT 84119-3602

Phone

(801) 965-3608

NPI assigned

Jan 24, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Etta Ivyn Chavez 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.

• Volunteers of America

  • Community/Behavioral Health Agency
  • Salt Lake City, UT
  • NPI 1598192338
  NPD (past)

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

{
    "created_epoch": "1579824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725062400000",
    "number": "1225668668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1375 N SCOTTSDALE RD STE 200",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852573429",
            "telephone_number": "480-877-9284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2965 W 3500 S",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841193602",
            "telephone_number": "801-965-3608"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12391 S 4000 W",
            "address_purpose": "LOCATION",
            "city": "Riverton",
            "state": "UT",
            "postal_code": "840967012",
            "country_code": "US",
            "telephone_number": "801-302-1700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHOENIX",
        "first_name": "IVY",
        "middle_name": "MARE",
        "credential": "CMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-24",
        "last_updated": "2024-08-31",
        "certification_date": "2024-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": "11772649-6004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ETTA",
            "last_name": "CHAVEZ",
            "middle_name": "IVYN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Mental Health Counselor in West Valley City, UT
• Providers in West Valley City, UT by specialty
• Mental Health Counselor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2024; 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.