Provider Demographics
NPI:1750035663
Name:BUFFALO ROAM THERAPY, LLC
Entity Type:Organization
Organization Name:BUFFALO ROAM THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AUBREE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCMFT, LMFT
Authorized Official - Phone:913-214-2987
Mailing Address - Street 1:10436 KING ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66214-2673
Mailing Address - Country:US
Mailing Address - Phone:785-766-2904
Mailing Address - Fax:
Practice Address - Street 1:8101 COLLEGE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2671
Practice Address - Country:US
Practice Address - Phone:913-214-2987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)