Independent US Healthcare Provider Directory & Public Medical Database
Deactivated NPI 1114904646 Deactivated / Inactive NPI Male Practitioner

Gregory Carl Nickles , LPC

Counselor - Professional • Kearns, UT

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Gregory Nickles has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date December 27, 2005
NPI Deactivation Date May 31, 2017
Total Practice Duration ~12 Years of Practice (2005 – 2017)

Professional Overview & Biography Verified Profile Summary

Gregory Nickles, LPC was a registered Counselor - Professional practicing in Kearns, UT. Throughout an active medical career spanning 12 years, Gregory Nickles provided care at the practice location at 3809 W 6200 S until profile deactivation on 2017-05-31.

Practice Location & Contact Primary Location

Practice Address

3809 W 6200 S

Kearns, UT 841183725

Telephone 8019634200
Fax 8019634299
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Counselor - Professional in Kearns, UT

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 18.5 Yrs
Regional Practice Density
5 Specialists

Practicing in Kearns, UT (520 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Counselor - Professional Primary Specialty

NUCC Taxonomy Code: 101YP2500X

State License UT 304614-6004

Definition to come...

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

22 Associated Practitioners
Pilitia Margraff

Community Health Worker

NPI 1003500828
NPI 1013646017

MS(CLINICALPSYCH)

Dr. Alyssa Levy , PhD

Psychologist - Clinical

NPI 1043296205

Doctor of Philosophy (Ph.D.)

Rose Medcalf

Psychologist - School

NPI 1073294195
Raeanna Kirk , RN

Registered Nurse - Psychiatric/Mental Health, Child & Adolescent

NPI 1124096417

Registered Nurse

Abby Butler

Social Worker

NPI 1184401366

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated May 31, 2017

Record deactivated on May 31, 2017

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 3809 W 6200 S, KEARNS, UT 841183725 (Tel: 8019634200)

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Updated Business Mailing Address July 08, 2007

Registered at 3536 MASON VISTA WAY, MAGNA, UT 840443505 (Tel: 8012506959)

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Provider Name / Credentials Updated July 08, 2007

Recorded as GREGORY NICKLES, LPC

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Counselor (License #304614-6004 in UT)

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Initial NPI Registration & Enumeration December 27, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1114904646
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: December 27, 2005
Last Update: July 08, 2007
Deactivation Date: May 31, 2017

Mailing Address

3536 Mason Vista Way

Magna, UT 840443505

Phone: 8012506959

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.