Doctor Name: | KAREN SULLIVAN |
NPI Number: | 1073938734 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 180.007150 |
Business Practice Address: | 111 S Virginia St Ste L03 Crystal Lake, IL - 600145853 |
Business Phone Number: | 8157152813 |
Business Fax Number: | |
Mailing Address: | 36 S Walkup Ave, CRYSTAL LAKE |
State: | IL |
Postal Code: | 600146130 |
Phone Number: | 8157152813 |
Fax Number: | |
NPI Enumeration Date: | 03/04/2014 |
NPI Last Update Date: | 03/04/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 180.007150 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |