NPIMap

Organization Active NPI

Charles L Diviney III MC LPC NCC LLC

  • Professional Counselor
  • SLC, UT
National Provider Identifier
1235447772
Registry record updated Oct 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
340426-6004 Issued in UT
Legal business name
CHARLES L DIVINEY III MC LPC NCC LLC
Practice address
352 S Denver St Ste 350
SLC, UT 84111-3059
Phone
(801) 521-4227
Fax
(801) 359-0777
NPI assigned
Sep 17, 2010
Last updated
Oct 2, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2025

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

Authorized official

Name
Debra Morrill
Title
Billing Manager
Phone
(801) 916-1645

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Clinical Nurse Specialist 364SP0808X 210158-4405 UT
Professional Counselor 101YP2500X 340426-6004 UT Primary
Professional Counselor 101YP2500X 5170621-6004 UT
Clinical Social Worker 1041C0700X 6281940-3501 UT

Addresses

Primary practice location

352 S Denver St Ste 350
SLC, UT 84111-3059

Mailing address

PO Box 3872
SLC, UT 84110-3872
Phone (801) 521-4227

Other identifiers 1

IdentifierTypeStateIssuer
340426600001001OtherUTBCBS UT

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121108000061 UT Part B Supplier - Clinic/Group Practice 7416108030 Receives reassigned benefits from 3 practitioners
Practice locations: Salt Lake City, UT

National Provider Directory

National Provider Directory

Locations

352 S Denver St
Ste 350
Slc, UT 84111
Phone (801) 521-4227

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1284681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759363200000",
    "number": "1235447772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3872",
            "city": "SLC",
            "state": "UT",
            "postal_code": "841103872",
            "telephone_number": "801-521-4227",
            "fax_number": "801-359-0777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "352 S DENVER ST STE 350",
            "city": "SLC",
            "state": "UT",
            "postal_code": "841113059",
            "telephone_number": "801-521-4227",
            "fax_number": "801-359-0777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES L DIVINEY III MC LPC NCC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-17",
        "last_updated": "2025-10-02",
        "certification_date": "2025-10-02",
        "status": "A",
        "authorized_official_last_name": "MORRILL",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "801-916-1645"
    },
    "taxonomies": [
        {
            "code": "364SP0808X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": "UT",
            "license": "210158-4405",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "UT",
            "license": "340426-6004",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "UT",
            "license": "5170621-6004",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "6281940-3501",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS UT",
            "identifier": "340426600001001",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in SLC, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.