Doctor Name: | MRS. MARY LOU SULL |
NPI Number: | 1346316106 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PCC-S,LSW,LICDC |
License Number: | E0002000 |
Business Practice Address: | 14843 W Sprague Rd Ste A Strongsville, OH - 441361754 |
Business Phone Number: | 4402349955 |
Business Fax Number: | 4402345994 |
Mailing Address: | 1124 Molland Dr, BRUNSWICK |
State: | OH |
Postal Code: | 442126415 |
Phone Number: | 3302259415 |
Fax Number: | |
NPI Enumeration Date: | 11/25/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | E0002000 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |