Provider Demographics
NPI:1053068429
Name:VERNON PSYCHOLOGY, LLC
Entity Type:Organization
Organization Name:VERNON PSYCHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TOMMI
Authorized Official - Middle Name:J
Authorized Official - Last Name:VERNON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:303-570-7256
Mailing Address - Street 1:430 N HARTSTRAIT RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-9780
Mailing Address - Country:US
Mailing Address - Phone:303-570-7256
Mailing Address - Fax:
Practice Address - Street 1:1117 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3385
Practice Address - Country:US
Practice Address - Phone:303-570-7256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health