Provider Demographics
NPI:1669090205
Name:CORDERY, MARIAH DELAINEY (MA, LPC, CMHC)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:DELAINEY
Last Name:CORDERY
Suffix:
Gender:F
Credentials:MA, LPC, CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4013 DEVONAIRE DR
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-3520
Mailing Address - Country:US
Mailing Address - Phone:325-650-1431
Mailing Address - Fax:
Practice Address - Street 1:4868 W RED MOUNTAIN CIR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-7577
Practice Address - Country:US
Practice Address - Phone:325-650-1431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80090101YP2500X
UT11751015-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional