MEDICARE: EUGENIA TYHERIA LYNN SANFORD MA, LPCC

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	101YM0800X	Mental Health Counselor	LPCC.0019589	CO

General Provider Information

NPI Number	:	1083341374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENIA TYHERIA LYNN SANFORD MA, LPCC

Provider Business Mailing Address
First Line	:	701 CHERRY AVE
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80304-4398
Country	:	US
Telephone Number	:	303-905-5112
Fax Number	:

Provider Business Practice Location Address
First Line	:	5485 CONESTOGA CT STE 110B
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80301-2752
Country	:	US
Telephone Number	:	303-905-5112
Fax Number	:

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

Provider Enumeration Date	:	08/05/2022
Last Update Date	:	08/05/2022

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