Provider Demographics
NPI:1265010078
Name:MY CORE THERAPY, LLC
Entity Type:Organization
Organization Name:MY CORE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:801-616-7135
Mailing Address - Street 1:395 E 60 S
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-3835
Mailing Address - Country:US
Mailing Address - Phone:801-763-7263
Mailing Address - Fax:
Practice Address - Street 1:395 E 60 S
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-3835
Practice Address - Country:US
Practice Address - Phone:801-763-7263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health