Derra Gullickson, MA, PSYD
Clinical Psychologist · Provo, UT
Derra Gullickson, MA, PSYD is a clinical psychologist with a practice address in Provo, Utah, and NPI 1255851333, issued on Jun 21, 2017. Check the license (Utah 10979353-2501, as entered in NPPES) with the Utah board that licenses this profession; the Medicare figures below come from public CMS files.
- Name
- Derra Gullickson
- Credential
- MA, PSYD
- Primary taxonomy
- Clinical Psychologist 103TC0700X
- License number
- 10979353-2501 UT
Self-reported in NPPES; status is on the state search - Practice location
- 750 N Freedom Blvd, Provo, UT 84601
- Phone
- (801) 373-4760
- Enumerated
- Jun 21, 2017
- Record last updated
- Oct 31, 2019 (not updated in 7 years: call before relying on the address or phone)
- Fax
- (801) 373-0639
- Medicare enrollment
- Enrolled (PECOS I20191211001458); accepts Medicare assignment
- Entity
- Type 1 · individual
Also registered at 750 N Freedom Blvd
A shared address usually means a shared clinic or building; it does not show who employs whom.
- Abigail AckleyCase Manager/Care Coordinator1841801206
- Brandi AdamsPeer Specialist1992241509
- Elnora AdamsStudent in an Organized Health Care Education/Training Program1821843558
- Keiran AdamsCase Manager/Care Coordinator1396466397
- Kimber AdamsCase Manager/Care Coordinator1528817616
- Rachel AdamsCase Manager/Care Coordinator1720750466
Verify Derra Gullickson in five checks
- 1IdentityNPI record in CMS NPPESNPI lookupConfirmed in NPPES
- 2LicenseActive license and public ordersWhich Utah board licenses this profession
Search for license 10979353-2501Check the board - 3Other statesLicenses and actions elsewhereDocInfo (FSMB)Not checked
- 4ExclusionsMedicare and Medicaid bansHHS-OIG exclusion listNot checked
- 5CertificationBoard certificationABMS AOA NCCPA AANPNot checked
Bills Medicare through one group practice
- Wasatch Behavioral Health Special Service DistrictProvo, UT
Source: CMS Doctors and Clinicians National Downloadable File (the group practices a clinician bills Medicare through) (data.cms.gov).
59 clinical psychologist records list a practice address in Provo
They are 59 of the 5,405 NPPES records with a practice address in Provo, and 437 clinical psychologist records in Utah.
All 59 in Provo → All 437 in Utah → Every provider in Provo →
Other clinical psychologist records in Utah
- Aylin Acosta, PSYDProvo, UT1750773784
- Chauncey Adams, PHDSt George, UT1437251170
- Jonathan Ahern, PH.D.Ogden, UT1437400447
- Thomas Aikins, PH.D.Salt Lake City, UT1295775898
- Elizabeth Albertsen, PSY.D.West Valley City, UT1871575472
- Geraldine Alldredge, PHDSpringville, UT1598877706
- Steven Allen, PHDSalt Lake City, UT1508804840
- Aaron Allred, PH.D.Orem, UT1326561408
- Chris Anderson, PHDAlpine, UT1699355784
- Kent Anderson, PHDProvidence, UT1932231016
Common questions
What is Derra Gullickson, MA, PSYD's NPI number?
Derra Gullickson, MA, PSYD's National Provider Identifier (NPI) is 1255851333, issued on Jun 21, 2017. An NPI identifies a provider in billing; it is not a license.
Where is Derra Gullickson, MA, PSYD located?
The NPPES record lists a practice address at 750 N Freedom Blvd, Provo, UT, 84601. Phone: (801) 373-4760. Providers update this record themselves, so call before visiting.
How can I verify Derra Gullickson, MA, PSYD's license?
NPPES lists Utah license number 10979353-2501, as entered by the provider. Search the Utah board that licenses this profession; the NPPES record confirms identity only.
Source: CMS National Plan and Provider Enumeration System (NPPES), file of Aug 9, 2026 (NPPES files on CMS.gov); NUCC Health Care Provider Taxonomy. Medicare files from data.cms.gov. An NPI identifies who bills; it is not a license.
Figures on PlainDoctor are read from the federal files each page names (CMS NPPES, Medicare Part D, MIPS, Open Payments; the HHS-OIG exclusion list only as counts) and from Census population estimates, with the file date shown beside them. See our editorial standards & corrections policy, the methodology behind these numbers, or report a data error. Data current as of Aug 9, 2026.