Nicole I Medina, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

10158726-2501 Issued in UT

Practice address

5965 S 900 E
Murray, UT 84121-1757

Phone

(801) 872-5516

NPI assigned

Sep 7, 2012

Last updated

Aug 11, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Nicole Shewey Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Little Black Cat Counseling and Healing

  • Psychologist
  • Salt Lake City, UT
  • NPI 1801518063
  NPD Authorized official
• Ascendant Behavioral Health LLC

  dba Ascendant Behavioral Health DBA LifeStance

  • Clinical Social Worker
  • Murray, UT
  • NPI 1689128605
  NPD
• Neurobehavioral Center for Growth LLC

  • Psychologist
  • Bountiful, UT
  • NPI 1942641931
  NPD
• Valor Psychological Services, LLC

  • Clinical Psychologist
  • Sandy, UT
  • NPI 1457881955
  NPD

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

{
    "created_epoch": "1346976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691712000000",
    "number": "1235488008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5965 S 900 E STE 100",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841211850",
            "telephone_number": "801-872-5516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5965 S 900 E",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841211757",
            "telephone_number": "801-872-5516"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8160 S Highland Dr Ste C104",
            "address_purpose": "LOCATION",
            "city": "Sandy",
            "state": "UT",
            "postal_code": "84093",
            "country_code": "US",
            "telephone_number": "801-850-4382",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8184 S Highland Dr Ste C-104",
            "address_purpose": "LOCATION",
            "city": "Sandy",
            "state": "UT",
            "postal_code": "840936477",
            "country_code": "US",
            "telephone_number": "385-645-4357",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3737 w 4100 S Suite 200",
            "address_purpose": "LOCATION",
            "city": "West Valley City",
            "state": "UT",
            "postal_code": "84120",
            "country_code": "US",
            "telephone_number": "888-949-4864",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "NICOLE",
        "middle_name": "I",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-07",
        "last_updated": "2023-08-11",
        "certification_date": "2023-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "UT",
            "license": "10158726-2501",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "UT",
            "license": "10158726-2501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROFESSIONAL LICENSE",
            "identifier": "10158726-2501",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235488008",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "SHEWEY",
            "credential": "PSYD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kaylin Meade
• John O Meadors, DC
• Cathy Meadows, RN
• Samantha Mecham
• Brooke Medina
• Kimberly Dawn Megwalu, APRN
• Alexis Marie Mehr, DPT
• Shelley Mehr
• Kailene Meiners
• Meliai PLLC

• Clinical Psychologist in Murray, UT
• Providers in Murray, UT by specialty
• Clinical Psychologist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.