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General NPI Number Information
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NPI Number | 1497005805
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Entity Type | Organization
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Legal Business Name | AMANDA L SULLIVAN, PC
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 01/08/2019
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Provider Practice Location Address
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Address Line | 770 N COTNER BLVD STE 330
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City | LINCOLN
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State | NE
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Zip | 68505-2377
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Country | US
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Telephone | 402-904-4067
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Fax |
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Provider Business Mailing Address
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Address Line | 770 N COTNER BLVD STE 330
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City | LINCOLN
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State | NE
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Zip | 68505-2377
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Country | US
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Telephone | 402-904-4067
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | AMANDA L SULLIVAN
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Credential | LMHP, CMSW
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Telephone | 402-432-0679
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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