Provider Demographics
NPI:1598055147
Name:IL SIGNIFICATO
Entity Type:Organization
Organization Name:IL SIGNIFICATO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:REICH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT
Authorized Official - Phone:801-450-7893
Mailing Address - Street 1:8160 HIGHLAND DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-6492
Mailing Address - Country:US
Mailing Address - Phone:801-450-7893
Mailing Address - Fax:
Practice Address - Street 1:8160 HIGHLAND DR
Practice Address - Street 2:SUITE 209
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-6492
Practice Address - Country:US
Practice Address - Phone:801-450-7893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-17
Last Update Date:2011-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2736693902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty