Provider Demographics
NPI:1952418105
Name:VLOSKY, MARK (PHD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:VLOSKY
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 1:11811 UPHAM ST
Mailing Address - Street 2:STE C
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-2777
Mailing Address - Country:US
Mailing Address - Phone:303-465-4654
Mailing Address - Fax:303-469-9331
Practice Address - Street 1:11811 UPHAM ST
Practice Address - Street 2:STE C
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-2777
Practice Address - Country:US
Practice Address - Phone:303-465-4654
Practice Address - Fax:303-469-9331
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO859103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical