| Broadvistas Psychology Llc | |
|
5555 S Elati St Littleton CO 80120-1624 | |
| (888) 948-6789 | |
| (877) 345-3501 |
| Full Name | Broadvistas Psychology Llc |
|---|---|
| Speciality | Psychologist |
| Location | 5555 S Elati St, Littleton, Colorado |
| Authorized Official Name and Position | Thomas Broadhurst (PSYCHOLOGIST) |
| Authorized Official Contact | 7208388141 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Broadvistas Psychology Llc 1 Kalisa Way Ste 101 Paramus NJ 07652-3508 Ph: (888) 948-6789 | Broadvistas Psychology Llc 5555 S Elati St Littleton CO 80120-1624 Ph: (888) 948-6789 |
| NPI Number | 1326422759 |
|---|---|
| Provider Enumeration Date | 07/15/2015 |
| Last Update Date | 05/22/2023 |
| Certification Date | 05/22/2023 |
| Medicare PECOS PAC ID | 0749595312 |
|---|---|
| Medicare Enrollment ID | O20150812007479 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326422759 | NPI | - | NPPES |
| PSY.0004234 | Other | CO | PROFESSIONAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY.0004234 (Colorado) | Primary |
| Provider Name | Thomas J Broadhurst |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1699972323 PECOS PAC ID: 1658686225 Enrollment ID: I20150812007579 |
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