Provider Demographics
NPI:1205358553
Name:SMITH, NICOLE GREENWOOD (LCSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:GREENWOOD
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:GREENWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1372
Mailing Address - Street 2:
Mailing Address - City:JULIAN
Mailing Address - State:CA
Mailing Address - Zip Code:92036-1372
Mailing Address - Country:US
Mailing Address - Phone:801-803-1557
Mailing Address - Fax:
Practice Address - Street 1:276 E 950 S STE 200
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-7054
Practice Address - Country:US
Practice Address - Phone:801-227-0734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT117055683502101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor