Derra Gullickson, MA, PSYD in Provo, UT - Medicare Clinical Psychologist Provider

Derra Gullickson, MA, PSYD is a medicare enrolled "Psychologist - Clinical" provider in Provo, Utah. She graduated from medical school in 2018 and has 6 years of diverse experience with area of expertise as Clinical Psychologist. She is a member of the group practice Wasatch Behavioral Health Special Service District and her current practice location is 750 N Freedom Blvd, Provo, Utah. You can reach out to her office (for appointments etc.) via phone at (801) 373-4760.

Derra Gullickson is licensed to practice in Utah (license number 10979353-2501) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1255851333.

Contact Information

	Derra Gullickson, MA, PSYD
	750 N Freedom Blvd, Provo, UT 84601-1677
	(801) 373-4760
	(801) 373-0639

Map and Direction

Healthcare Provider's Profile

Full Name	Derra Gullickson
Gender	Female
Speciality	Clinical Psychologist
Experience	6 Years
Location	750 N Freedom Blvd, Provo, Utah
Accepts Medicare Assignments	Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Derra Gullickson graduated from medical school in 2018

NPI Data:

NPI Number: 1255851333
Provider Enumeration Date: 06/21/2017
Last Update Date: 10/31/2019

Medicare PECOS Information:

PECOS PAC ID: 8224461926
Enrollment ID: I20191211001458

Medical Identifiers

Medical identifiers for Derra Gullickson such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1255851333	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
103TC0700X	Psychologist - Clinical	10979353-2501 (Utah)	Primary

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Wasatch Behavioral Health Special Service District	2567367915	73

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Derra Gullickson allows following entities to bill medicare on her behalf.

Entity Name	Wasatch Behavioral Health Special Service District
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1356357115 PECOS PAC ID: 2567367915 Enrollment ID: O20031129000014

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Derra Gullickson is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Derra Gullickson, MA, PSYD 750 N Freedom Blvd, Provo, UT 84601-1677 Ph: (801) 373-4760	Derra Gullickson, MA, PSYD 750 N Freedom Blvd, Provo, UT 84601-1677 Ph: (801) 373-4760

Reviews and Comments

Psychologist in Provo, UT

Eliza Rachelle Gedge, PH.D., LP Psychologist Medicare: Medicare Enrolled Practice Location: 750 N Freedom Blvd, Provo, UT 84601 Phone: 801-373-0639 Fax: 801-373-0639
Vaughn E Worthen, PH.D. Psychologist Medicare: Not Enrolled in Medicare Practice Location: 1545 Wsc, Provo, UT 84602 Phone: 801-471-6266
Prof. Benjamin Mckay Ogles, PHD Psychologist Medicare: Not Enrolled in Medicare Practice Location: 1190 N 900 E, Provo, UT 84604 Phone: 801-422-8193
Dr. Kari A O'grady, PSYCHOLOGIST Psychologist Medicare: Not Enrolled in Medicare Practice Location: 1508 Springdell Cir, Provo, UT 84604 Phone: 410-952-2207
Michaela Shields, PSYD Psychologist Medicare: Medicare Enrolled Practice Location: 1300 E Center St, Provo, UT 84606 Phone: 801-344-4215
Dr. R. Lynn Richards, PHD Psychologist Medicare: Medicare Enrolled Practice Location: 1432 E. 850 S., Provo, UT 84606 Phone: 801-371-8787 Fax: 801-371-8784
Dr. Max Ford Mcbride, PH.D. Psychologist Medicare: Accepting Medicare Assignments Practice Location: 1055 N 300 W, Suite 414, Provo, UT 84604 Phone: 801-357-7757 Fax: 801-357-8100

Derra Gullickson, MA, PSYD - Medicare Psychologist in Provo, UT