Healthcare Provider Details

I. General information

NPI: 1104996545
Provider Name (Legal Business Name): DANIEL JOSEPH SULLIVAN PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 OFFICE PARK CIR STE 214A
MOUNTAIN BRK AL
35223-2572
US

IV. Provider business mailing address

4 OFFICE PARK CIR STE 214A
MOUNTAIN BRK AL
35223-2572
US

V. Phone/Fax

Practice location:
  • Phone: 205-335-0691
  • Fax: 205-941-8074
Mailing address:
  • Phone: 205-335-0691
  • Fax: 205-941-8074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1803
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number02543
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: