Healthcare Provider Details

I. General information

NPI: 1407763337
Provider Name (Legal Business Name): HAROLD ROBERT SULLIVAN III QMHS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 E LIVINGSTON AVE
COLUMBUS OH
43205-2926
US

IV. Provider business mailing address

1334 COURTRIGHT RD
COLUMBUS OH
43227-2203
US

V. Phone/Fax

Practice location:
  • Phone: 614-253-4448
  • Fax: 614-917-0744
Mailing address:
  • Phone: 614-253-4448
  • Fax: 614-917-0744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1124907753
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: