Organization
SUMMIT PSYCHOLOGICAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY A BLANEY PSYD (OWNER)
(307) 684-9360
Entity
Organization
Contact information
Practice address
182 N MAIN ST, BUFFALO, WY 82834-1727
(307) 684-9360
(307) 684-5187
Mailing address
182 N MAIN ST, BUFFALO, WY 82834-1727
(307) 684-9360
(307) 684-5187
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
328
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117880601
—
WY
Enumeration date
11/08/2010
Last updated
11/08/2010
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