1942690706 NPI number — MRS. SARA BEA SULLIVAN M.S., LPC

Table of content: MRS. SARA BEA SULLIVAN M.S., LPC (NPI 1942690706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942690706 NPI number — MRS. SARA BEA SULLIVAN M.S., LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SULLIVAN
Provider First Name:
SARA
Provider Middle Name:
BEA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942690706
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1003 HUGH WALLIS RD S BLDG E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70508-2528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-534-8140
Provider Business Mailing Address Fax Number:
337-534-8141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
913 S COLLEGE RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70503-3060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-230-3375
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2015

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: 101YM0800X , with the licence number:  5457 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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