Individual
NICOLE SMALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3751 BLACKSTONE DR UNIT 3I, PARK CITY, UT 84098-6783
(917) 589-0863
Mailing address
3751 BLACKSTONE DR UNIT 3I, PARK CITY, UT 84098-6783
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
13214858-6004
UT
Other
Enumeration date
04/30/2025
Last updated
04/30/2025
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