| Theo Riley Phd Llc | |
|
1001 14th St Cody WY 82414-3745 | |
| (307) 587-9503 | |
| Not Available |
| Full Name | Theo Riley Phd Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1001 14th St, Cody, Wyoming |
| Authorized Official Name and Position | Theo A Riley (PSYCHOLOGIST) |
| Authorized Official Contact | 30758795503 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Theo Riley Phd Llc Po Box 2082 Cody WY 82414-2082 Ph: () - | Theo Riley Phd Llc 1001 14th St Cody WY 82414-3745 Ph: (307) 587-9503 |
| NPI Number | 1861569360 |
|---|---|
| Provider Enumeration Date | 11/29/2006 |
| Last Update Date | 10/18/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861569360 | NPI | - | NPPES |
| 121524800 | Medicaid | WY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 200 (Wyoming) | Primary |
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