Provider Demographics
NPI:1528262748
Name:SULLIVAN, ELIZABETH A (LPC)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:A
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3012 TRAVIS CT
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-3969
Mailing Address - Country:US
Mailing Address - Phone:989-430-4381
Mailing Address - Fax:989-839-2610
Practice Address - Street 1:3012 TRAVIS CT
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-3969
Practice Address - Country:US
Practice Address - Phone:989-430-4381
Practice Address - Fax:989-839-2610
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401002570101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional