MEDICARE: BRITTANY N SULLIVAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457828535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY N SULLIVAN

Provider Business Mailing Address
First Line	:	3225 BROOKEN HILL DR
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72908-9251
Country	:	US
Telephone Number	:	479-462-3340
Fax Number	:

Provider Business Practice Location Address
First Line	:	3225 BROOKEN HILL DR
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72908-9251
Country	:	US
Telephone Number	:	479-462-3340
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2018
Last Update Date	:	04/04/2025

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Directions to “ BRITTANY N SULLIVAN ” Practice Location

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