MEDICARE: MR. MARK DOUGLAS SELLERS MA, MA, LPC

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	101Y00000X	Counselor	2908	CO

General Provider Information

NPI Number	:	1205028362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK DOUGLAS SELLERS MA, MA, LPC

Provider Business Mailing Address
First Line	:	7222 COMMERCE CENTER DR
Second Line	:	SUITE 110
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-2630
Country	:	US
Telephone Number	:	719-268-9600
Fax Number	:

Provider Business Practice Location Address
First Line	:	7222 COMMERCE CENTER DR
Second Line	:	SUITE 110
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-2630
Country	:	US
Telephone Number	:	719-268-9600
Fax Number	:

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

Provider Enumeration Date	:	08/13/2007
Last Update Date	:	08/13/2007

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