Individual
DR. PETER MICHAEL NICHOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
780 GUARDSMAN WAY, SALT LAKE CITY, UT 84108-1374
(801) 581-0194
(801) 581-0193
Mailing address
780 GUARDSMAN WAY, SALT LAKE CITY, UT 84108-1374
(801) 581-0194
(801) 581-0193
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1192563501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107001279101
INTERMOUNTAIN HEALTH CARE
UT
01
—
289948
DESERET MUTUAL
UT
01
—
942938348NI1
EDUCATOR'S MUTUAL
UT
Enumeration date
01/13/2006
Last updated
03/17/2008
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