Provider Demographics
NPI:1558040667
Name:GALLI, NICK (PHD, ACMHC)
Entity Type:Individual
Prefix:DR
First Name:NICK
Middle Name:
Last Name:GALLI
Suffix:
Gender:M
Credentials:PHD, ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10908 S WEISS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-7745
Mailing Address - Country:US
Mailing Address - Phone:801-674-2184
Mailing Address - Fax:
Practice Address - Street 1:10908 S WEISS DR
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84009-7745
Practice Address - Country:US
Practice Address - Phone:801-674-2184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12993710-6009101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional