Provider Demographics
NPI:1225668668
Name:PHOENIX, IVY MARE (CMHC)
Entity type:Individual
Prefix:
First Name:IVY
Middle Name:MARE
Last Name:PHOENIX
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:ETTA
Other - Middle Name:IVYN
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1375 N SCOTTSDALE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-3429
Mailing Address - Country:US
Mailing Address - Phone:480-877-9284
Mailing Address - Fax:
Practice Address - Street 1:2965 W 3500 S
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-3602
Practice Address - Country:US
Practice Address - Phone:801-965-3608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11772649-6004101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health