NPIMap

Organization Active NPI

Integrative Counseling, LLC

  • Mental Health Counselor
  • Sandy, UT
National Provider Identifier
1508486473
Registry record updated Apr 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
INTEGRATIVE COUNSELING, LLC
Practice address
510 E Sego Lily Dr
Sandy, UT 84070-3546
Phone
(801) 793-0620
Fax
(844) 440-5778
NPI assigned
Apr 21, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2020

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

Authorized official

Name
Shelley Folsom Mangum, LCMHCNPI 1396009262
Title
Owner
Phone
(801) 793-0620

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

510 E Sego Lily Dr
Sandy, UT 84070-3546

Mailing address

510 E Sego Lily Dr
Sandy, UT 84070-3546
Phone (801) 793-0620

Other identifiers 1

IdentifierTypeStateIssuer
5828209-6004OtherUTLCMHC

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL https://www.srfax.com Direct

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1587427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587427200000",
    "number": "1508486473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 E SEGO LILY DR",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840703546",
            "telephone_number": "801-793-0620",
            "fax_number": "844-440-5778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 E SEGO LILY DR",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840703546",
            "telephone_number": "801-793-0620",
            "fax_number": "844-440-5778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-21",
        "last_updated": "2020-04-21",
        "certification_date": "2020-04-21",
        "status": "A",
        "authorized_official_last_name": "MANGUM",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_middle_name": "FOLSOM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-793-0620",
        "authorized_official_credential": "LCMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LCMHC",
            "identifier": "5828209-6004",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://www.srfax.com",
            "affiliation": "N",
            "endpointDescription": "SRFax HIPAA Compliant Fax System",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Faxed PDF",
            "address_1": "510 E Sego Lily Dr",
            "city": "Sandy",
            "state": "UT",
            "country_code": "US",
            "postal_code": "840703546",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sandy, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2020; 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.