Provider Demographics
NPI:1457592644
Name:THERAPEUTIC EXPERIENCES, LLC
Entity Type:Organization
Organization Name:THERAPEUTIC EXPERIENCES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:TYNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-749-0607
Mailing Address - Street 1:120 COUNTY ROAD 236
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-8298
Mailing Address - Country:US
Mailing Address - Phone:970-749-0607
Mailing Address - Fax:970-247-2724
Practice Address - Street 1:120 COUNTY ROAD 236
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-8298
Practice Address - Country:US
Practice Address - Phone:970-749-0607
Practice Address - Fax:970-247-2724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO225800000X, 251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Single Specialty