Active NPI
Simon Daniel Nicolia, CSWI
- Mental Health Counselor
- South Jordan, UT
National Provider Identifier
1467730887
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 5990693-3506
- Practice address
- 873 Baxter Dr
South Jordan, UT 84095-8506 - Phone
- (801) 548-1347
- NPI assigned
- Aug 2, 2011
- Sex
- Male
- Sole proprietor
- No
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 | 5990693-3506 | UT | Primary |
Addresses
Primary practice location
873 Baxter Dr
South Jordan, UT 84095-8506
Mailing address
P.O Box 708458
Sandy, UT 84070
Phone (801) 548-1347
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 |
|---|---|---|---|
| 5990693-3506 | UT | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1312243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312243200000",
"number": "1467730887",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O BOX 708458",
"city": "SANDY",
"state": "UT",
"postal_code": "84070",
"telephone_number": "801-548-1347"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "873 BAXTER DR",
"city": "SOUTH JORDAN",
"state": "UT",
"postal_code": "840958506",
"telephone_number": "801-548-1347"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICOLIA",
"first_name": "SIMON",
"middle_name": "DANIEL",
"credential": "CSWI",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-08-02",
"last_updated": "2011-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "UT",
"license": "5990693-3506",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Jordan, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.