Medina, Nicole I

Medina, Nicole I is an individual health care provider with primary practice located at 5965 S 900 E , Murray UT 84121-1757. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Psychologist. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Medina, Nicole I can be contacted via phone (801) 872-5516.

Contact Information

Primary practice address
5965 S 900 E Murray UT 84121-1757
Phone: (801) 872-5516
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 10158726-2501 Utah
Behavioral Health & Social Service Providers / Psychologist 103T00000X 10158726-2501 Utah

Profile Details

NPI number 1235488008
LBN Legal business name Medina, Nicole I
Credentials PSYD
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 7th, 2012
Last updated Aug 11th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235488008 NPPES
Utah Other 10158726-2501 PROFESSIONAL LICENSE
Utah MEDICAID 1235488008 PROFESSIONAL LICENSE

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