Doctor Name: | COREY JAMES MARKISICH |
NPI Number: | 1033438288 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LSAC |
License Number: | 7220715-6006 |
Business Practice Address: | 7300 S 300 W Suite 101 Midvale, UT - 840471962 |
Business Phone Number: | 8019841717 |
Business Fax Number: | 8019841720 |
Mailing Address: | 2179 N 725 W, WEST BOUNTIFUL |
State: | UT |
Postal Code: | 840871104 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 05/27/2010 |
NPI Last Update Date: | 05/03/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 7220715-6006 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |