=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235285487
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SULLIVAN, NOLAN & ASSOCIATES, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2007
-----------------------------------------------------
Last Update Date | 04/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3700 W LIBERTY RD
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48103-9056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-426-0032
-----------------------------------------------------
Fax | 734-426-0034
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3700 W LIBERTY RD
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48103-9056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-426-0032
-----------------------------------------------------
Fax | 734-426-0034
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KRISTINA RASK
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 734-426-0032
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 6301006105
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------