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General NPI Number Information
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NPI Number | 1902385388
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Entity Type | Individual
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Provider Name | TYRA B VICKERS PHD
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Gender | Female
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Dates
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Enumeration Date | 08/07/2018
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Last Update Date | 08/07/2018
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Provider Practice Location Address
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Address Line | 5860 S CURTICE ST
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City | LITTLETON
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State | CO
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Zip | 80120-1909
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Country | US
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Telephone | 720-316-3909
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Fax |
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Provider Business Mailing Address
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Address Line | 12151 W MOUNT POWELL
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City | LITTLETON
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State | CO
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Zip | 80127-3201
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Country | US
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Telephone | 303-304-6657
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 39807
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 13939
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License Number State | CO
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