Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 2764 | KS |
NPI | 1003365693 |
---|---|
Provider Name | Kathyrn Sullivan |
First Address | Overland Park, KS 66210-1100 |
Second Address | Overland Park, KS 66210-1100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2016 |
Last Update Date | 24/09/2016 |