Provider Demographics
NPI:1861894537
Name:SULLIVAN, KAREN S (MA, PLMHP, LADC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MA, PLMHP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7117 FARNAM ST STE 17
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-3319
Mailing Address - Country:US
Mailing Address - Phone:531-301-7817
Mailing Address - Fax:402-885-7596
Practice Address - Street 1:2112 W FAIDLEY AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4670
Practice Address - Country:US
Practice Address - Phone:083-398-5328
Practice Address - Fax:308-398-5404
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
NE1242101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker