Provider Demographics
NPI:1457537490
Name:BLUE RIDGE PSYCHOTHERAPY & CONSULTATION ASSOCIATES, PC
Entity Type:Organization
Organization Name:BLUE RIDGE PSYCHOTHERAPY & CONSULTATION ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:RAMSEY
Authorized Official - Last Name:TELSCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:540-460-3017
Mailing Address - Street 1:2424 MAGNOLIA AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BUENA VISTA
Mailing Address - State:VA
Mailing Address - Zip Code:24416-3026
Mailing Address - Country:US
Mailing Address - Phone:540-460-3017
Mailing Address - Fax:
Practice Address - Street 1:2424 MAGNOLIA AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BUENA VISTA
Practice Address - State:VA
Practice Address - Zip Code:24416-3026
Practice Address - Country:US
Practice Address - Phone:540-460-3017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-19
Last Update Date:2011-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001331103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA079179OtherANTHEM
VA079179OtherANTHEM