Provider Demographics
NPI:1528558004
Name:OPEN RANGE TELEPSYCHIATRY LLC
Entity Type:Organization
Organization Name:OPEN RANGE TELEPSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAY
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:812-384-5237
Mailing Address - Street 1:30 N GOULD ST STE 7141
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-6362
Mailing Address - Country:US
Mailing Address - Phone:307-278-7542
Mailing Address - Fax:
Practice Address - Street 1:30 N GOULD ST STE 7141
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-6362
Practice Address - Country:US
Practice Address - Phone:307-278-7542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty