Healthcare Provider Details

I. General information

NPI: 1831955657
Provider Name (Legal Business Name): LISA MARIA SULLIVAN-JASON LMHC LPC MHSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 RELIANCE DR
FRANKLIN TN
37067-1755
US

IV. Provider business mailing address

1234 RELIANCE DR
FRANKLIN TN
37067-1755
US

V. Phone/Fax

Practice location:
  • Phone: 508-237-2027
  • Fax:
Mailing address:
  • Phone: 508-237-2027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6731
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10000630
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: