Provider Demographics
NPI:1710122908
Name:ABINTRA PSYCHOLOGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ABINTRA PSYCHOLOGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FAULKNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:307-684-5828
Mailing Address - Street 1:135 PINE ST STE B
Mailing Address - Street 2:PO BOX 1222
Mailing Address - City:BUFFALO
Mailing Address - State:WY
Mailing Address - Zip Code:82834-2332
Mailing Address - Country:US
Mailing Address - Phone:307-684-5828
Mailing Address - Fax:307-684-5803
Practice Address - Street 1:135 PINE ST STE B
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:WY
Practice Address - Zip Code:82834-2332
Practice Address - Country:US
Practice Address - Phone:307-684-5828
Practice Address - Fax:307-684-5803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY#268103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty