Active NPI
Nicole Wall, LCMHC
- Mental Health Counselor
- Bountiful, UT
National Provider Identifier
1336538412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 8180027-6004
- Practice address
- 1355 N Main St
Suite 1
Bountiful, UT 84010-5981 - Phone
- (801) 660-5233
- Fax
- (801) 295-4201
- NPI assigned
- Jan 13, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 8180027-6004 | UT | Primary |
Addresses
Primary practice location
1355 N Main St
Suite 1
Bountiful, UT 84010-5981
Mailing address
1355 North Main Street
Suite 1
Bountiful, UT 84010
Phone (801) 660-5233
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8180027-6004 | UT | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421107200000",
"number": "1336538412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1355 NORTH MAIN STREET",
"address_2": "SUITE 1",
"city": "BOUNTIFUL",
"state": "UT",
"postal_code": "84010",
"telephone_number": "801-660-5233",
"fax_number": "801-295-4201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1355 N MAIN ST",
"address_2": "SUITE 1",
"city": "BOUNTIFUL",
"state": "UT",
"postal_code": "840105981",
"telephone_number": "801-660-5233",
"fax_number": "801-295-4201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALL",
"first_name": "NICOLE",
"name_prefix": "Ms.",
"credential": "LCMHC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-01-13",
"last_updated": "2015-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "UT",
"license": "8180027-6004",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bountiful, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.