Healthcare Provider Details

I. General information

NPI: 1174248504
Provider Name (Legal Business Name): ELIZABETH KATHLEEN SULLIVAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2022
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 S LEXINGTON ST
HARRISONVILLE MO
64701-2444
US

IV. Provider business mailing address

2118 N 25TH ST
OZARK MO
65721-9689
US

V. Phone/Fax

Practice location:
  • Phone: 417-413-3826
  • Fax:
Mailing address:
  • Phone: 417-413-3826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2022034539
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2022034539
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: