Healthcare Provider Details

I. General information

NPI: 1922945708
Provider Name (Legal Business Name): AMBER SULLIVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2863 BROOKSIDE AVE
INDIANAPOLIS IN
46218-4447
US

IV. Provider business mailing address

332 BERNARD AVE
INDIANAPOLIS IN
46208-3825
US

V. Phone/Fax

Practice location:
  • Phone: 765-617-6031
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: