Provider Demographics
NPI:1811885361
Name:SMITH, CODY RAY
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:RAY
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 S 550 E STE 240
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-7795
Mailing Address - Country:US
Mailing Address - Phone:801-382-9455
Mailing Address - Fax:
Practice Address - Street 1:1429 S 550 E STE 240
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-7795
Practice Address - Country:US
Practice Address - Phone:801-382-9455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health