Provider Demographics
NPI:1295016178
Name:HUNTER, NICHOLE THOMPSON (LCSW)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:THOMPSON
Last Name:HUNTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:431 W RIVER WAY RD
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-4601
Mailing Address - Country:US
Mailing Address - Phone:801-473-4539
Mailing Address - Fax:
Practice Address - Street 1:750 N 200 W
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-1677
Practice Address - Country:US
Practice Address - Phone:801-373-7393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7454862-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical