Provider Demographics
NPI:1538323712
Name:ADAMS, CORY SCOTT
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:SCOTT
Last Name:ADAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2377 GOLD MEADOW WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4444
Mailing Address - Country:US
Mailing Address - Phone:916-956-5736
Mailing Address - Fax:
Practice Address - Street 1:2377 GOLD MEADOW WAY STE 100
Practice Address - Street 2:
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-4444
Practice Address - Country:US
Practice Address - Phone:916-956-5736
Practice Address - Fax:916-550-0213
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA90378106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000008462OtherMEDICAL PROVIDER NUMBER