Provider Demographics
NPI:1841044658
Name:TOMASULA MARTIN, LILY (MFTC)
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:TOMASULA MARTIN
Suffix:
Gender:F
Credentials:MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 29TH ST UNIT 1292
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1010
Mailing Address - Country:US
Mailing Address - Phone:303-564-2756
Mailing Address - Fax:
Practice Address - Street 1:1601 29TH ST UNIT 1292
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1010
Practice Address - Country:US
Practice Address - Phone:303-564-2756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0014519106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist