Provider Demographics
NPI:1750689592
Name:RAMOS, NICOLE MICHELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MICHELLE
Last Name:RAMOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 E 12300 S STE C408
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7976
Mailing Address - Country:US
Mailing Address - Phone:801-671-9519
Mailing Address - Fax:801-855-7547
Practice Address - Street 1:1848 E AMERICAN WAY UNIT 3
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-6316
Practice Address - Country:US
Practice Address - Phone:801-583-2500
Practice Address - Fax:801-855-7547
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9517464-35011041C0700X
UT9517464-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical