Provider Demographics
NPI:1518609700
Name:RILEY, CORI (LPC-A)
Entity Type:Individual
Prefix:
First Name:CORI
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 HWY 121 BYP STE A250
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-4183
Mailing Address - Country:US
Mailing Address - Phone:940-280-3700
Mailing Address - Fax:
Practice Address - Street 1:405 HWY 121 BYP STE A250
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4183
Practice Address - Country:US
Practice Address - Phone:940-280-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-08
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85397101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health