Healthcare Provider Details

I. General information

NPI: 1821909854
Provider Name (Legal Business Name): MS. SARAH LEE SULLIVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1844 OAK HOLLOW DR STE B
TRAVERSE CITY MI
49686-5924
US

IV. Provider business mailing address

12299 S ELLIS AVE UNIT 312
TRAVERSE CITY MI
49684-2712
US

V. Phone/Fax

Practice location:
  • Phone: 231-714-0282
  • Fax:
Mailing address:
  • Phone: 231-714-0282
  • 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: