Provider Demographics
NPI:1366527343
Name:CHERTUDI, NIKOLAS (LPC)
Entity type:Individual
Prefix:MR
First Name:NIKOLAS
Middle Name:
Last Name:CHERTUDI
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 W HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-3021
Mailing Address - Country:US
Mailing Address - Phone:435-734-9449
Mailing Address - Fax:
Practice Address - Street 1:241 W 1700 N
Practice Address - Street 2:
Practice Address - City:NORTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414-7265
Practice Address - Country:US
Practice Address - Phone:801-388-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT500556-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional