Individual
COREY JAMES MARKISICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSAC
Contact information
Practice address
7300 S 300 W, SUITE 101, MIDVALE, UT 84047-1962
(801) 984-1717
(801) 984-1720
Mailing address
2179 N 725 W, WEST BOUNTIFUL, UT 84087-1104
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
7220715-6006
UT
Other
Enumeration date
05/27/2010
Last updated
05/03/2012
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