1841440799 NPI number — MRS. KELLI ANN SULLIVAN MFT

Table of content: MRS. KELLI ANN SULLIVAN MFT (NPI 1841440799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841440799 NPI number — MRS. KELLI ANN SULLIVAN MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SULLIVAN
Provider First Name:
KELLI
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FITZGERALD
Provider Other First Name:
KELLI
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841440799
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
510 STATE STREET SUITE 270
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA BARBARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-252-5034
Provider Business Mailing Address Fax Number:
805-564-2486

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 STATE STREET SUITE 270
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-252-5034
Provider Business Practice Location Address Fax Number:
805-564-2486
Provider Enumeration Date:
09/29/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFT#44932 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)