Doctor Name: | MICHAEL ANDREW SULLIVAN |
NPI Number: | 1841528585 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.A., LMHC |
License Number: | 001217 |
Business Practice Address: | 974 73rd St Ste 9 Windsor Heights, IA - 503241026 |
Business Phone Number: | 5154434980 |
Business Fax Number: | |
Mailing Address: | 974 73rd St Ste 9, WINDSOR HEIGHTS |
State: | IA |
Postal Code: | 503241026 |
Phone Number: | 5154434980 |
Fax Number: | |
NPI Enumeration Date: | 11/18/2009 |
NPI Last Update Date: | 06/24/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 001217 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |