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General NPI Number Information
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NPI Number | 1326422759
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Entity Type | Organization
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Legal Business Name | BROADVISTAS PSYCHOLOGY LLC
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Dates
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Enumeration Date | 07/15/2015
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 3420 MILL VISTA RD
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80129-2324
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Country | US
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Telephone | 888-948-6789
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Fax | 877-345-3501
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Provider Business Mailing Address
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Address Line | 1 KALISA WAY STE 101
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City | PARAMUS
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State | NJ
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Zip | 07652-3508
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Country | US
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Telephone | 888-948-6789
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Fax | 877-345-3501
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | THOMAS BROADHURST
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Credential | PSYD
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Telephone | 720-838-8141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY.0004234
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License Number State | CO
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