Nicole Ivancovich, LMHCA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MC61062470 Issued in WA

Practice address

9523 232ND St SW
Edmonds, WA 98020-5028

Phone

(206) 218-9395

NPI assigned

May 31, 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

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.

• Nicole Ivancovich Therapy

  • Mental Health Counselor
  • Edmonds, WA
  • NPI 1245923242
  NPD Authorized official

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

{
    "created_epoch": "1590883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590883200000",
    "number": "1770107377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9523 232ND ST SW",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980205028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9523 232ND ST SW",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980205028",
            "telephone_number": "206-218-9395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVANCOVICH",
        "first_name": "NICOLE",
        "credential": "LMHCA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-31",
        "last_updated": "2020-05-31",
        "certification_date": "2020-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "MC61062470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Integrative Psychological and Social Services
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• Nancy B Isenberg, MD
• Maggie C Ishaq, MS, LMHC, SUDP, CCS
• Virginia Smith Isler
• J & J Pharmacy
• Helen Marie Jackson, LICSW
• Nanette Kaiuelani Jackson
• Gary J Jacky, DMD
• Carole J Jacobson, LMFT

• Mental Health Counselor in Edmonds, WA
• Providers in Edmonds, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.