Active NPI
Edward Omar Ontiveros, LAC
- Mental Health Counselor
- Tempe, AZ
National Provider Identifier
1457074098
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LAC-21115
- Practice address
- 4801 S Lakeshore Dr Ste 106
Tempe, AZ 85282-7156 - Phone
- (480) 525-0058
- NPI assigned
- Sep 20, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LAC-21115 | AZ | Primary |
Addresses
Primary practice location
4801 S Lakeshore Dr Ste 106
Tempe, AZ 85282-7156
Mailing address
3924 E Minton St
Phoenix, AZ 85042-6229
Phone (602) 821-9386
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LAC-21115 | AZ | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663632000000",
"number": "1457074098",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3924 E MINTON ST",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850426229",
"telephone_number": "602-821-9386"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4801 S LAKESHORE DR STE 106",
"city": "TEMPE",
"state": "AZ",
"postal_code": "852827156",
"telephone_number": "480-525-0058"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ONTIVEROS",
"first_name": "EDWARD",
"middle_name": "OMAR",
"name_prefix": "Mr.",
"credential": "LAC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-09-20",
"last_updated": "2022-09-20",
"certification_date": "2022-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "AZ",
"license": "LAC-21115",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tempe, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.