Provider Demographics
NPI:1811102106
Name:MEACHAM, KORY L (MAED, LPC, CMHC)
Entity type:Individual
Prefix:
First Name:KORY
Middle Name:L
Last Name:MEACHAM
Suffix:
Gender:M
Credentials:MAED, LPC, CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:672 W 1000 S
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-3037
Mailing Address - Country:US
Mailing Address - Phone:435-633-1701
Mailing Address - Fax:
Practice Address - Street 1:672 W 1000 S
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-3037
Practice Address - Country:US
Practice Address - Phone:435-633-1701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5522172-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT149820155OtherDRIVERS LICENCE NUMBER