Derra Gullickson, MA, PSYD

NPI #1255851333 in Provo, Utah

Provider Information

NPI Number: 1255851333
Entity Type: Individual
Name: Derra Gullickson, MA, PSYD
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Psychologist - Clinical
Credential: MA, PSYD
Enumeration Date: Jun 21, 2017
Last Updated: Oct 31, 2019

Practice Location

Address: 750 N FREEDOM BLVD
City: Provo
State: Utah
ZIP Code: 84601-1677
Phone: (801) 373-4760

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist - Clinical — Clinical	103TC0700X	Primary

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