Provider Demographics
NPI:1255789897
Name:SLOVICK, JAY THOMAS (RP)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:THOMAS
Last Name:SLOVICK
Suffix:
Gender:M
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 W. CROSS DRIVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-0700
Mailing Address - Country:US
Mailing Address - Phone:720-933-1958
Mailing Address - Fax:720-862-2086
Practice Address - Street 1:9200 W. CROSS DRIVE
Practice Address - Street 2:SUITE 225
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-0700
Practice Address - Country:US
Practice Address - Phone:720-933-1958
Practice Address - Fax:720-862-2086
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2016-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONA.00742550376K00000X
CONLC.0106360101YM0800X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No376K00000XNursing Service Related ProvidersNurse's Aide
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health