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General NPI Number Information
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NPI Number | 1073946083
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Entity Type | Individual
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Provider Name | LEANNE SULLIVAN M.A., LMHCA
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Gender | Female
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Dates
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Enumeration Date | 08/13/2013
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Last Update Date | 08/13/2013
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Provider Practice Location Address
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Address Line | 2832 S MERIDIAN SUITE 101
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City | PUYALLUP
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State | WA
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Zip | 98373-1447
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Country | US
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Telephone | 253-474-7188
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Fax | 253-446-7137
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Provider Business Mailing Address
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Address Line | 4227 S MERIDIAN SUITE #C-576
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City | PUYALLUP
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State | WA
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Zip | 98373-3603
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Country | US
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Telephone | 253-474-7188
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Fax | 253-446-7137
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | MC 60398056
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MC 60398056
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | MC 60398056
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License Number State | WA
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