Provider Demographics
NPI:1194340448
Name:CHEEK-O'DONNELL, NICHOLAS MAURICE (LCSW)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:MAURICE
Last Name:CHEEK-O'DONNELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:NICO
Other - Middle Name:
Other - Last Name:CHEEK-O'DONNELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1950 CIRCLE OF HOPE DR
Mailing Address - Street 2:BMT CLINIC
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84112
Mailing Address - Country:US
Mailing Address - Phone:801-587-4695
Mailing Address - Fax:
Practice Address - Street 1:1950 CIRCLE OF HOPE DR
Practice Address - Street 2:BMT CLINIC
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112
Practice Address - Country:US
Practice Address - Phone:801-587-4695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT894744335011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT89474433501OtherDIVISION OF OCCUPATIONAL & PROFESSIONAL LICENSING - ACTIVE LICENSE REFERENCE NUM