Provider Demographics
NPI:1902652274
Name:OUTSIDE THERAPY LLC
Entity Type:Organization
Organization Name:OUTSIDE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCSHANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-221-0317
Mailing Address - Street 1:4726 MOUNTAIN RD APT 520
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-5157
Mailing Address - Country:US
Mailing Address - Phone:307-221-0317
Mailing Address - Fax:
Practice Address - Street 1:1520 LOGAN AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5138
Practice Address - Country:US
Practice Address - Phone:307-221-0317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-27
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty