Provider Demographics
NPI:1063073450
Name:WYE OAK THERAPEUTIC SERVICES, LLC
Entity type:Organization
Organization Name:WYE OAK THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:443-249-2601
Mailing Address - Street 1:165 LOG CANOE CIR STE B-3
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2149
Mailing Address - Country:US
Mailing Address - Phone:443-249-3351
Mailing Address - Fax:
Practice Address - Street 1:165 LOG CANOE CIR STE B-3
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-2149
Practice Address - Country:US
Practice Address - Phone:443-249-3351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty