Provider Demographics
NPI:1447925607
Name:CORLEY, CARY (DOC)
Entity type:Individual
Prefix:DR
First Name:CARY
Middle Name:
Last Name:CORLEY
Suffix:
Gender:M
Credentials:DOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 NE SUNDERLAND CT
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-1609
Mailing Address - Country:US
Mailing Address - Phone:816-490-1352
Mailing Address - Fax:
Practice Address - Street 1:3367 NE RALPH POWELL RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2368
Practice Address - Country:US
Practice Address - Phone:816-663-9751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014043322101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional