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General NPI Number Information
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NPI Number | 1083093702
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Entity Type | Organization
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Legal Business Name | DC CORGIAT LLC
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Dates
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Enumeration Date | 05/27/2015
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Last Update Date | 05/27/2015
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Provider Practice Location Address
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Address Line | 1916 N 700 W STE 190
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City | LAYTON
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State | UT
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Zip | 84041-5726
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Country | US
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Telephone | 801-820-6169
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Fax |
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Provider Business Mailing Address
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Address Line | 1916 N 700 W STE 190
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City | LAYTON
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State | UT
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Zip | 84041-5726
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Country | US
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Telephone | 801-820-6169
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Fax |
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Authorized Official
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Title or Position | SOLE OWNER
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Name | DAMON CORGIAT
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Credential |
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Telephone | 801-808-7435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 9133595-6010
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License Number State | UT
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