Provider Demographics
NPI:1417484205
Name:RICE, COREY
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:RICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1553 G86 LN
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-3205
Mailing Address - Country:US
Mailing Address - Phone:970-874-0464
Mailing Address - Fax:970-874-0464
Practice Address - Street 1:115 GRAND AVE
Practice Address - Street 2:STE 2
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-2000
Practice Address - Country:US
Practice Address - Phone:970-874-0464
Practice Address - Fax:970-874-0464
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician