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General NPI Number Information
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NPI Number | 1497037444
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Entity Type | Individual
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Provider Name | SEAN KATHARINE SULLIVAN M.A., LPC-INTERN
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Gender | Female
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Dates
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Enumeration Date | 09/15/2011
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Last Update Date | 09/15/2011
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Provider Practice Location Address
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Address Line | 2458 E 11TH ST
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City | ODESSA
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State | TX
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Zip | 79761-4236
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Country | US
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Telephone | 432-582-2444
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Fax | 432-582-2449
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Provider Business Mailing Address
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Address Line | 2458 E 11TH ST
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City | ODESSA
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State | TX
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Zip | 79761-4236
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Country | US
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Telephone | 432-582-2444
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Fax | 432-582-2449
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 66857
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License Number State | TX
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