Healthcare Provider Details

I. General information

NPI: 1346568318
Provider Name (Legal Business Name): JULIE GOUDIE-NICE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE NICE

II. Dates (important events)

Enumeration Date: 05/14/2010
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 HARRISON BLVD
OGDEN UT
84403-4311
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-5600
  • Fax: 801-475-1621
Mailing address:
  • Phone: 801-387-5600
  • Fax: 801-475-1621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7431224-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: