Alivia Tess Irwin, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

377869 3501 Issued in UT

Practice address

380 N 200 W Ste 206
Bountiful, UT 84010

Phone

(801) 447-1392

NPI assigned

Aug 30, 2006

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

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Neurobehavioral Center for Growth LLC

  • Psychologist
  • Bountiful, UT
  • NPI 1942641931
  NPD (past)

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571356800000",
    "number": "1992815138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1832 JERI DR",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840105316",
            "telephone_number": "801-647-3119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 N 200 W STE 206",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "84010",
            "telephone_number": "801-447-1392"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "415 Medical Dr",
            "address_2": "Ste D101",
            "address_purpose": "LOCATION",
            "city": "Bountiful",
            "state": "UT",
            "postal_code": "840104946",
            "country_code": "US",
            "telephone_number": "801-683-1062",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IRWIN",
        "first_name": "ALIVIA",
        "middle_name": "TESS",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2019-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "377869 3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Integrated Functional Medicine, LLC
• Integrated Wellness Group LLC
• Integrated Wellness Group LLC
• Integrated Wellness of Salt Lake
• Integrative Functional Nutrition
• Cory Dan Irwin
• Grace Isaacson, DO
• Stephanie Jackson, D.P.T.
• Kendra Mkirie Jacobs
• Madison Mariah Jacobs

• All providers in Bountiful, UT
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2019; 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.