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NPI Code Detail

MEDICARE: BROADVISTAS PSYCHOLOGY LLC

MEDICARE: BROADVISTAS PSYCHOLOGY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1699383109
Entity Type Code : Organization
Provider Name (Legal Business Name) : BROADVISTAS PSYCHOLOGY LLC
Provider Business Mailing Address
First Line : 1 KALISA WAY STE 101
Second Line :
City : PARAMUS
State : NJ
Zip : 07652-3508
Country : US
Telephone Number : 888-948-6789
Fax Number : 877-345-3501
Provider Business Practice Location Address
First Line : 3131 S FEDERAL BLVD
Second Line :
City : DENVER
State : CO
Zip : 80236-2713
Country : US
Telephone Number : 888-948-6789
Fax Number : 877-345-3501
Authorized Official
Title or Position : OWNER
Name : THOMAS J BROADHURST
Credential : PSYD
Telephone Number : 720-838-8141
Provider Enumeration Date : 07/21/2020
Last Update Date : 01/06/2023

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Directions to “BROADVISTAS PSYCHOLOGY LLC ” Practice Location

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