Healthcare Provider Details

I. General information

NPI: 1205028362
Provider Name (Legal Business Name): MARK DOUGLAS SELLERS MA, MA, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7222 COMMERCE CENTER DR SUITE 110
COLORADO SPRINGS CO
80919-2630
US

IV. Provider business mailing address

7222 COMMERCE CENTER DR SUITE 110
COLORADO SPRINGS CO
80919-2630
US

V. Phone/Fax

Practice location:
  • Phone: 719-268-9600
  • Fax:
Mailing address:
  • Phone: 719-268-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2908
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: