Ivana Micic

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

9424937-3501 Issued in UT

Practice address

150 E 700 S
Project Reality
Salt Lake City, UT 84111-3806

Phone

(801) 364-8080

NPI assigned

Jul 24, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Project Reality

  • Mental Health Counselor
  • Salt Lake City, UT
  • NPI 1134211626
  Medicare reassignment NPD
• Project Reality

  • Clinic/Center
  • Salt Lake City, UT
  • NPI 1750473237

  Mental Health

  NPD (past)
• Sacred Spaces LLC

  • Clinical Social Worker
  • West Valley City, UT
  • NPI 1104699693
  NPD (past)

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

{
    "created_epoch": "1374624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655856000000",
    "number": "1801238431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "166 E COATSVILLE AVE",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841151925",
            "telephone_number": "801-615-4246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 E 700 S",
            "address_2": "PROJECT REALITY",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841113806",
            "telephone_number": "801-364-8080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICIC",
        "first_name": "IVANA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-07-24",
        "last_updated": "2022-06-22",
        "certification_date": "2022-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": "9424937-3501",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patrick V. Michelier, MD
• Michelle E Murday MD PC
• Michelle Gourley & Associates, LLC
• Julia Kleschen Michels
• Kim James Michelson, D.D.S.
• Meagan Ann Mickelsen
• Sara Marie Mickelson, R.D., M.B.A.
• Janelle Miconi
• Middleton Urological Associates
• Anthony W Middleton Jr., M.D.

• Mental Health Counselor in Salt Lake City, UT
• Providers in Salt Lake 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 Jun 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.