Provider Demographics
NPI:1801832878
Name:VARVIL-WELD, DOUGLAS CHARLES (PHD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:CHARLES
Last Name:VARVIL-WELD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4860 ROBB ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-2184
Mailing Address - Country:US
Mailing Address - Phone:303-278-7418
Mailing Address - Fax:303-223-9315
Practice Address - Street 1:5822 S LOWELL WAY
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-2849
Practice Address - Country:US
Practice Address - Phone:303-422-1533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3703103TC0700X
CO0003703103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11493250OtherCAQH
CO40920089Medicaid
COPSY.0003703OtherPROFESSIONAL LICENSE
CO404893Medicare PIN