| Doctor Name: | MR. GREGORY CARL NICKLES |
| NPI Number: | 1114904646 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC |
| License Number: | 304614-6004 |
| Business Practice Address: | 3809 W 6200 S Kearns, UT - 841183725 |
| Business Phone Number: | 8019634200 |
| Business Fax Number: | 8019634299 |
| Mailing Address: | 3536 Mason Vista Way, MAGNA |
| State: | UT |
| Postal Code: | 840443505 |
| Phone Number: | 8012506959 |
| Fax Number: | 8012528417 |
| NPI Enumeration Date: | 12/27/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 304614-6004 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |