MEDICARE: TRICIA SULLIVAN BORELLI LMHC

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	00342	IA

General Provider Information

NPI Number	:	1760443535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRICIA SULLIVAN BORELLI LMHC

Provider Business Mailing Address
First Line	:	3340 DAVID DR
Second Line	:
City	:	DUBUQUE
State	:	IA
Zip	:	52002-2905
Country	:	US
Telephone Number	:	563-213-4259
Fax Number	:

Provider Business Practice Location Address
First Line	:	2728 ASBURY RD
Second Line	:
City	:	DUBUQUE
State	:	IA
Zip	:	52001-2971
Country	:	US
Telephone Number	:	563-556-9642
Fax Number	:

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	11/16/2011

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