Healthcare Provider Details

I. General information

NPI: 1396584942
Provider Name (Legal Business Name): LAUREN ELIZABETH SULLIVAN LPC, CRC, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 SW GREENWICH DR
LEES SUMMIT MO
64082-4408
US

IV. Provider business mailing address

116 E SPOTSWOOD AVE
ELKTON VA
22827-1512
US

V. Phone/Fax

Practice location:
  • Phone: 951-290-7570
  • Fax:
Mailing address:
  • Phone: 951-290-7570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2021050564
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: