Provider Demographics
NPI:1013540640
Name:WAYMARK PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:WAYMARK PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:720-695-3369
Mailing Address - Street 1:6535 S DAYTON ST STE 3650
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-6135
Mailing Address - Country:US
Mailing Address - Phone:720-695-3369
Mailing Address - Fax:720-780-2069
Practice Address - Street 1:6535 S DAYTON ST STE 3650
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-6135
Practice Address - Country:US
Practice Address - Phone:720-695-3369
Practice Address - Fax:720-780-2069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty