Provider Demographics
NPI:1922610922
Name:CORLEY, ALICIA JEAN
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:JEAN
Last Name:CORLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:JEAN
Other - Last Name:CORLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3155 SNOW TRILLIUM WAY
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-9204
Mailing Address - Country:US
Mailing Address - Phone:720-295-3790
Mailing Address - Fax:877-400-4480
Practice Address - Street 1:3155 SNOW TRILLIUM WAY
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-9204
Practice Address - Country:US
Practice Address - Phone:720-295-3790
Practice Address - Fax:877-400-4480
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician