Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 81147 | TX |
NPI | 1003579798 |
---|---|
Provider Name | Rheanne Sullivan |
First Address | Graham, TX 76450-4216 |
Second Address | Graham, TX 76450-4216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2021 |
Last Update Date | 19/10/2021 |