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General NPI Number Information
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NPI Number | 1184254120
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Entity Type | Individual
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Provider Name | NATALIA PELLANDINI SULLIVAN MS, LPC, LMFT
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Gender | Female
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Dates
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Enumeration Date | 01/17/2020
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Last Update Date | 01/17/2020
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Provider Practice Location Address
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Address Line | 1237 FRONT ST
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City | CONWAY
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State | AR
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Zip | 72032-4101
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Country | US
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Telephone | 501-580-7181
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Fax |
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Provider Business Mailing Address
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Address Line | 2910 E MOORE AVE APT 55
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City | SEARCY
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State | AR
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Zip | 72143-4846
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Country | US
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Telephone | 501-580-7181
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | P1803029
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License Number State | AR
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