Provider Demographics
NPI:1114371580
Name:CORNER CANYON COUNSELING
Entity Type:Organization
Organization Name:CORNER CANYON COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-816-1801
Mailing Address - Street 1:248 E 13800 S
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-5010
Mailing Address - Country:US
Mailing Address - Phone:801-816-1801
Mailing Address - Fax:801-501-0249
Practice Address - Street 1:248 E 13800 S
Practice Address - Street 2:SUITE 4
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-5010
Practice Address - Country:US
Practice Address - Phone:801-816-1801
Practice Address - Fax:801-501-0249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT135945-3501251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health