Healthcare Provider Details

I. General information

NPI: 1215292990
Provider Name (Legal Business Name): TERESA MARIE SULLIVAN L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 PLAZA DRIVE SUITE 105
HIGHLANDS RANCH CO
80129
US

IV. Provider business mailing address

630 PLAZA DRIVE SUITE 105
HIGHLANDS RANCH CO
80129
US

V. Phone/Fax

Practice location:
  • Phone: 303-471-9355
  • Fax: 720-306-8987
Mailing address:
  • Phone: 303-471-9355
  • Fax: 720-306-8987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberA0J.0001788
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1788
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: