Healthcare Provider Details

I. General information

NPI: 1548983547
Provider Name (Legal Business Name): COREWORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2732 W LIZZI CV
SOUTH JORDAN UT
84095-7961
US

IV. Provider business mailing address

1878 W 12600 S # 337
RIVERTON UT
84065-7026
US

V. Phone/Fax

Practice location:
  • Phone: 760-769-6637
  • Fax:
Mailing address:
  • Phone: 801-769-6637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: APRIL LYNNE' BENNETT
Title or Position: OWNER, DIRECTOR, THERAPIST
Credential: LMFT
Phone: 801-769-6637