Provider Demographics
NPI:1043759285
Name:REICH, CORY
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:REICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9980 S 300 W STE 105
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3641
Mailing Address - Country:US
Mailing Address - Phone:801-438-1385
Mailing Address - Fax:801-438-3184
Practice Address - Street 1:11762 S STATE ST
Practice Address - Street 2:STE 360
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7155
Practice Address - Country:US
Practice Address - Phone:801-438-3185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT273669-3902101YA0400X, 101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health