Healthcare Provider Details

I. General information

NPI: 1619227493
Provider Name (Legal Business Name): NIKI WOLFE CMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4578 S HIGHLAND DR STE 320
MILLCREEK UT
84117-4214
US

IV. Provider business mailing address

3709 E BROCKBANK DR
MILLCREEK UT
84124-3907
US

V. Phone/Fax

Practice location:
  • Phone: 801-505-9237
  • Fax:
Mailing address:
  • Phone: 801-706-5906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: