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General NPI Number Information
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NPI Number | 1063567493
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Entity Type | Organization
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Legal Business Name | MICHAEL SULLIVAN, MSW, INC.
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 09/06/2018
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Provider Practice Location Address
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Address Line | 304 GRAND AVE
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City | BILLINGS
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State | MT
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Zip | 59101
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Country | US
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Telephone | 406-245-4566
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Fax | 406-245-2441
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Provider Business Mailing Address
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Address Line | 304 GRAND AVE
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City | BILLINGS
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State | MT
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Zip | 59101-5923
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Country | US
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Telephone | 406-861-6389
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Fax | 406-245-2441
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MS. DIANE LYNN SULLIVAN
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Credential |
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Telephone | 406-861-6389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 192
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License Number State | MT
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