Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003021072 |
---|---|
Provider Name | Christian Sullivan |
First Address | Yakima, WA 98907-0959 |
Second Address | Yakima, WA 98902-3546 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2007 |
Last Update Date | 08/07/2007 |