Jason Cyril Willoughby, PSYD

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

PSY.0003944 Issued in CO

Practice address

3401 Eudora St
Denver, CO 80207-2500

Phone

(303) 300-6333

NPI assigned

Aug 6, 2010

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1281052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625616000000",
    "number": "1811202443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 EUDORA ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802072500",
            "telephone_number": "303-300-6333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 EUDORA ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802072500",
            "telephone_number": "303-300-6333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLOUGHBY",
        "first_name": "JASON",
        "middle_name": "CYRIL",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-06",
        "last_updated": "2021-07-07",
        "certification_date": "2021-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CO",
            "license": "PSY.0003944",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "CO",
            "license": "PSY.0003944",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "84281375",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stacy A Willis, PA-C
• Marylin Kay Willison, LPCC
• Anne Willits, CNM
• Linda Grimm Willits, RXN CNS
• Brian J Willoughby, M.D.
• Shaleigh Willoughby, MA.ED
• Amy Tindall Willson, MSW
• Christina Wilms
• Mahtab Wilsey
• Wilson Psychotherapy LLC

• Clinical Child & Adolescent Psychologist in Denver, CO
• Providers in Denver, CO by specialty
• Clinical Child & Adolescent Psychologist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.