=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437516762
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VCCD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2016
-----------------------------------------------------
Last Update Date | 02/24/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9200 W CROSS DR SUITE 225
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-358-3864
-----------------------------------------------------
Fax | 720-862-2086
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9200 W CROSS DR STE 225
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80123-0700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-688-5515
-----------------------------------------------------
Fax | 617-379-0496
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR & CEO
-----------------------------------------------------
Name | JAY THOMAS SLOVICK
-----------------------------------------------------
Credential | M.ED.
-----------------------------------------------------
Telephone | 720-688-5515
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------