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Active NPI 1255851333 Individual Practitioner Female Practitioner

Dr. Derra Gullickson , MA, PsyD

Psychologist - Clinical • Provo, UT

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Derra Gullickson, MA, PsyD is a certified Psychologist - Clinical practicing in Provo, UT. With approximately 8 years of clinical experience since completing medical education in 2018, Dr. Gullickson delivers high-quality medical care to the local community at 750 N FREEDOM BLVD.

Dr. Gullickson is affiliated with Wasatch Behavioral Health Special Service District and accepts Medicare assignment.

Practice Location & Contact Primary Location

Practice Address

750 N Freedom Blvd

Provo, UT 846011677

Telephone 8013734760
Fax 8013730639
Associated Practice Facility / Clinic

Medicare Profile & Education

Medical School

Other

Graduation Year

2018

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Psychologist - Clinical in Provo, UT

Experienced Practitioner (5-10 Yrs)
Practitioner Clinical Experience
8 Yrs -7.9 yrs vs City Avg
City Avg: 15.9 Yrs
State Avg: 23.9 Yrs
Regional Practice Density
61 Specialists

Practicing in Provo, UT (451 Statewide)

Telehealth Adoption Rate
9.8% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Gullickson (8 Years) 8 Yrs
Provo Specialty Average (15.9 Years) 15.9 Yrs

Medical Specialties & State Licenses

Psychologist - Clinical Primary Specialty

NUCC Taxonomy Code: 103TC0700X

State License UT 10979353-2501

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

Hospital & Practice Group Affiliations

Wasatch Behavioral Health Special Service District

750 N Freedom Blvd, Provo, UT 846011677

Phone: 8013734760

Secondary Practice Locations

705 N Freedom Blvd.

Provo, UT 84601

Phone: 6129106371

Practice Associates & Co-Workers

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

40 Associated Practitioners
Nicole Cossey , HSW

Case Manager/Care Coordinator

NPI 1003082793
Brent Simons

Social Worker

NPI 1003106196
Louie Hamner

Student in an Organized Health Care Education/Training Program

NPI 1003114232
Sunnie Giles

Student in an Organized Health Care Education/Training Program

NPI 1003194325
Dr. Eliza Gedge , PhD, LP

Psychologist - Clinical

NPI 1003197658

Doctor of Philosophy (Ph.D.), Licensed Psychologist

Vili Lolohea

Student in an Organized Health Care Education/Training Program

NPI 1003199191

Career & Practice History Timeline

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

10 Historical Events
📍
Updated Practice Location October 31, 2019

Registered at 750 N FREEDOM BLVD, PROVO, UT 846011677 (Tel: 8013734760)

📍
Updated Business Mailing Address October 31, 2019

Registered at 750 N FREEDOM BLVD, PROVO, UT 846011677 (Tel: 8013734760)

👤
Provider Name / Credentials Updated October 31, 2019

Recorded as DERRA GULLICKSON, MA, PSYD

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) October 31, 2019

Psychologist (License #10979353-2501 in UT)

NPI Profile Active June 21, 2017

NPI status registered as active in NPPES database

📍
Updated Practice Location June 21, 2017

Registered at 705 N FREEDOM BLVD., PROVO, UT 84601 (Tel: 6129106371)

📍
Updated Business Mailing Address June 21, 2017

Registered at 652 W 1428 S, OREM, UT 840587392 (Tel: 6129106371)

👤
Provider Name / Credentials Updated June 21, 2017

Recorded as DERRA GULLICKSON, MA

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) June 21, 2017

Student in an Organized Health Care Education/Training Program

🟢
Initial NPI Registration & Enumeration June 21, 2017

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: 1255851333
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: June 21, 2017
Last Update: October 31, 2019
Sole Proprietor: No

Mailing Address

750 N Freedom Blvd

Provo, UT 846011677

Phone: 8013734760

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.