Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 101YM0800X | Mental Health Counselor | IN |
NPI | 1003127226 |
---|---|
Provider Name | Mary Sullivan |
First Address | Merrillville, IN 46410-6123 |
Second Address | Merrillville, IN 46410-6123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2010 |
Last Update Date | 07/05/2019 |