MEDICARE: MARY SULLIVAN MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	LMFT-351	HI
2	106H00000X	Marriage & Family Therapist	MFT.0001310	CO

General Provider Information

NPI Number	:	1720410475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY SULLIVAN MFT

Provider Business Mailing Address
First Line	:	4333 CORBETT DR # 1196
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-6111
Country	:	US
Telephone Number	:	970-310-3406
Fax Number	:

Provider Business Practice Location Address
First Line	:	4333 CORBETT DR # 1196
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-6111
Country	:	US
Telephone Number	:	970-310-3406
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2013
Last Update Date	:	03/03/2025

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Directions to “ MARY SULLIVAN MFT” Practice Location

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