MEDICARE: VIRTUAL ASSESSMENTS, 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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	ACD.0000291	CO
2	101YM0800X	Mental Health Counselor	LPC.0011143	CO

General Provider Information

NPI Number	:	1780100537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRTUAL ASSESSMENTS, LLC

Provider Business Mailing Address
First Line	:	4045 WADSWORTH BLVD STE 306
Second Line	:
City	:	WHEAT RIDGE
State	:	CO
Zip	:	80033-4626
Country	:	US
Telephone Number	:	720-295-4852
Fax Number	:	720-306-3572

Provider Business Practice Location Address
First Line	:	4045 WADSWORTH BLVD STE 306
Second Line	:
City	:	WHEAT RIDGE
State	:	CO
Zip	:	80033-4626
Country	:	US
Telephone Number	:	720-295-4852
Fax Number	:	720-306-3572

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	CHARITY GRIMSLEY-HINKLEY
Credential	:	LPC, LAC, MAC, SAP
Telephone Number	:	720-295-4852

Provider Enumeration Date	:	08/14/2017
Last Update Date	:	05/11/2018

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