| Doctor Name: | MR. TIM D SULLIVAN |
| NPI Number: | 1003038753 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSW, LCSW |
| License Number: | SW 003553 |
| Business Practice Address: | 229 Ridgewood Ave Apartment 112 Minneapolis, MN - 554033554 |
| Business Phone Number: | 6126007169 |
| Business Fax Number: | |
| Mailing Address: | 229 Ridgewood Ave, Apartment 112 MINNEAPOLIS |
| State: | MN |
| Postal Code: | 554033554 |
| Phone Number: | 6126007169 |
| Fax Number: | |
| NPI Enumeration Date: | 05/03/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | SW 003553 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |