Provider Demographics
NPI:1063705168
Name:SUNDERLAND, HILLARY M (LCSW, LAC)
Entity type:Individual
Prefix:
First Name:HILLARY
Middle Name:M
Last Name:SUNDERLAND
Suffix:
Gender:F
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:HILLARY
Other - Middle Name:M
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5402 MONTEZUMA RD
Mailing Address - Street 2:
Mailing Address - City:MONTEZUMA
Mailing Address - State:CO
Mailing Address - Zip Code:80435-7621
Mailing Address - Country:US
Mailing Address - Phone:303-704-8555
Mailing Address - Fax:
Practice Address - Street 1:330 FIEDLER AVE STE 207
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:CO
Practice Address - Zip Code:80435-6930
Practice Address - Country:US
Practice Address - Phone:970-200-8563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO482101YA0400X
CO17921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01231782Medicaid