Provider Demographics
NPI:1730574237
Name:TIMOTHY S. SULLIVAN, PH.D,, LLC
Entity type:Organization
Organization Name:TIMOTHY S. SULLIVAN, PH.D,, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:713-820-4208
Mailing Address - Street 1:3869 DARROW RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-2691
Mailing Address - Country:US
Mailing Address - Phone:713-820-4208
Mailing Address - Fax:
Practice Address - Street 1:3869 DARROW RD
Practice Address - Street 2:SUITE 104
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-2691
Practice Address - Country:US
Practice Address - Phone:713-820-4208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5645103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty