Provider Demographics
NPI:1083093702
Name:DC CORGIAT LLC
Entity Type:Organization
Organization Name:DC CORGIAT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:CORGIAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-808-7435
Mailing Address - Street 1:1916 N 700 W STE 190
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-5726
Mailing Address - Country:US
Mailing Address - Phone:801-820-6169
Mailing Address - Fax:
Practice Address - Street 1:1916 N 700 W STE 190
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5726
Practice Address - Country:US
Practice Address - Phone:801-820-6169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9133595-6010101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty