Theo Riley PHD LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

200 Issued in WY

Legal business name

THEO RILEY PHD LLC

Practice address

1001 14TH St
Cody, WY 82414-3745

Phone

(307) 587-9503

NPI assigned

Nov 29, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Theo A Riley, PHD

Title

Psychologist

Phone

30758795503

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350518400000",
    "number": "1861569360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2082",
            "city": "CODY",
            "state": "WY",
            "postal_code": "824142082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 14TH ST",
            "city": "CODY",
            "state": "WY",
            "postal_code": "824143745",
            "telephone_number": "307-587-9503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEO RILEY PHD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2012-10-18",
        "status": "A",
        "authorized_official_last_name": "RILEY",
        "authorized_official_first_name": "THEO",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "30758795503",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "WY",
            "license": "200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121524800",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Cody, WY
• Providers in Cody, WY by specialty
• Psychologist in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.