Healthcare Provider Details

I. General information

NPI: 1871991877
Provider Name (Legal Business Name): NICE POULSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2014
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 S UNIVERSITY AVE
PROVO UT
84601-4427
US

IV. Provider business mailing address

151 S UNIVERSITY AVE
PROVO UT
84601-4427
US

V. Phone/Fax

Practice location:
  • Phone: 801-851-7127
  • Fax:
Mailing address:
  • Phone: 801-851-7127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9662021-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number9662021-6019
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: