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General NPI Number Information
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NPI Number | 1306582697
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Entity Type | Individual
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Provider Name | BRIAN O'SULLIVAN LMFT
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Gender | Male
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Dates
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Enumeration Date | 05/09/2022
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | MARUNAKA B-301, 5-CHOME-26-16
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City | GOYA, OKINAWA CITY
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State | OKINAWA
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Zip | 9040021
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Country | JP
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Telephone | 559-343-1458
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Fax |
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Provider Business Mailing Address
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Address Line | MARUNAKA B-301, 5-CHOME-26-16
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City | GOYA, OKINAWA CITY
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State | OKINAWA
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Zip | 9040021
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Country | JP
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Telephone |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT122484
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License Number State | CA
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