Derra Gullickson, MA, PSYD
NPI 1255851333 · Clinical Psychologist · Provo, UT
Enrolled with Medicare as Practitioner - Clinical Psychologist · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Derra Gullickson, MA, PSYD is a Clinical Psychologist provider in Provo, UT (NPI 1255851333).
Provider details
- NPI number
- 1255851333
- Entity type
- Individual
- Primary specialty
- Clinical PsychologistBehavioral Health & Social Service Providers
- Credential
- MA, PSYD
- Sex
- Female
- Sole proprietor
- No
- License
- 10979353-2501 (UT)
Specialties & taxonomies
Behavioral Health & Social Service Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
9 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
2 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Additional practice locations (1)
- 705 N Freedom Blvd.Provo, UT 84601Phone: (612) 910-6371
Registry dates
- Enumerated
- 2017-06-21
- Last updated
- 2019-10-31
Frequently asked questions
- What is Derra Gullickson's NPI number?
- Derra Gullickson's National Provider Identifier (NPI) is 1255851333, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What is Derra Gullickson's specialty?
- Derra Gullickson is listed in the NPPES registry with a primary specialty of Clinical Psychologist (Behavioral Health & Social Service Providers).
- Where is Derra Gullickson located?
- Derra Gullickson's practice location on file with NPPES is 750 N Freedom Blvd, Provo, UT 84601-1677.
- What is Derra Gullickson's phone number?
- The practice phone number listed in the NPPES registry for Derra Gullickson is (801) 373-4760.
- Does Derra Gullickson accept Medicare?
- Derra Gullickson is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Is Derra Gullickson's NPI active?
- Yes — Derra Gullickson's NPI (1255851333) is active in the NPPES registry as of the last update on 2019-10-31.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.