Healthcare Provider Details

I. General information

NPI: 1316173016
Provider Name (Legal Business Name): MARY TERESA LUNSFORD BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 06/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 E DICKENSON PL
DENVER CO
80222-6012
US

IV. Provider business mailing address

13298 RARITAN CT
WESTMINSTER CO
80234-1435
US

V. Phone/Fax

Practice location:
  • Phone: 303-504-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number94-076-2455
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: