Provider Demographics
NPI:1760443535
Name:BORELLI, TRICIA SULLIVAN (LMHC)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:SULLIVAN
Last Name:BORELLI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 DAVID DR
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2905
Mailing Address - Country:US
Mailing Address - Phone:563-213-4259
Mailing Address - Fax:
Practice Address - Street 1:2728 ASBURY RD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-2971
Practice Address - Country:US
Practice Address - Phone:563-556-9642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00342101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor