| Illuminate And Evolve Therapy | |
|
3435 S Brook View Ln Salt Lake City UT 84106-1593 | |
| (801) 633-6579 | |
| Not Available |
| Full Name | Illuminate And Evolve Therapy |
|---|---|
| Speciality | Social Worker |
| Location | 3435 S Brook View Ln, Salt Lake City, Utah |
| Authorized Official Name and Position | Mona Lisa Chavez Esqueda (OWNER/OPERATOR) |
| Authorized Official Contact | 8016336579 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Illuminate And Evolve Therapy 3435 S Brook View Ln Salt Lake City UT 84106-1593 Ph: (801) 633-6579 | Illuminate And Evolve Therapy 3435 S Brook View Ln Salt Lake City UT 84106-1593 Ph: (801) 633-6579 |
| NPI Number | 1932868528 |
|---|---|
| Provider Enumeration Date | 12/11/2021 |
| Last Update Date | 12/11/2021 |
| Certification Date | 12/11/2021 |
| Medicare PECOS PAC ID | 9537556048 |
|---|---|
| Medicare Enrollment ID | O20220503000542 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932868528 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Mona Lisa Chavez Esqueda |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649804980 PECOS PAC ID: 1355738865 Enrollment ID: I20220503000656 |
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