Healthcare Provider Details

I. General information

NPI: 1225896863
Provider Name (Legal Business Name): CORNER CANYON RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

782 E PIONEER RD
DRAPER UT
84020-5734
US

IV. Provider business mailing address

13020 S FORT ST
DRAPER UT
84020-9294
US

V. Phone/Fax

Practice location:
  • Phone: 877-226-0317
  • Fax: 801-384-0820
Mailing address:
  • Phone: 877-226-0317
  • Fax: 801-384-0820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRAD CHRISTENSEN
Title or Position: CHIEF PEOPLE OFFICER
Credential:
Phone: 801-994-6735