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Search › Utah › 103TC0700X

Derra Gullickson, MA, PSYD

NPI 1255851333 · on the registry since 2017

Practice

Address
750 N Freedom Blvd
Provo, UT 84601
Phone
(801) 373-4760
Fax
(801) 373-0639
Organisation at this address
Wasatch Mental Health
Wasatch Mental Health
Wasatch Mental Health
Wasatch Behavioral Health Special Service District
Inferred from a shared address, not stated in the registry.
Clinicians at this address
1,547

Additional practice sites

  • 705 N Freedom Blvd., Provo, UT

Registry record

Primary taxonomy
103TC0700X
103TC0700X
Licence states on file
UT
From the registry's licence fields, which are often incomplete.
Sex
Female
Record last updated
2019-10-31

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Utah