Illuminate and Evolve Therapy

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

ILLUMINATE AND EVOLVE THERAPY

Practice address

3435 S Brook View LN
Salt Lake City, UT 84106-1593

Phone

(801) 633-6579

NPI assigned

Dec 11, 2021

Organization subpart

No

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

Authorized official

Name

Mona Lisa Chavez Esqueda, MSW, LCSW, PH.D(ABD)

Title

Owner/Operator

Phone

(801) 633-6579

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1639180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639180800000",
    "number": "1932868528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3435 S BROOK VIEW LN",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841061593",
            "telephone_number": "801-633-6579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3435 S BROOK VIEW LN",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841061593",
            "telephone_number": "801-633-6579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLUMINATE AND EVOLVE THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-11",
        "last_updated": "2021-12-11",
        "certification_date": "2021-12-11",
        "status": "A",
        "authorized_official_last_name": "CHAVEZ ESQUEDA",
        "authorized_official_first_name": "MONA LISA",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "801-633-6579",
        "authorized_official_credential": "MSW, LCSW, PH.D(ABD)"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Torako Ikegami
• Eliza Eves Ikeler
• Lori Frances Ili
• Ava Karina Illingworth
• Seth M. Illu, MD
• Sarah Jane Ilstrup, MD
• Cecilia J. Im, MD
• Ima-SLC
• Noelia Imani
• Lindsey Marie Imber, RD

• Clinical Social Worker in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2021; 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.