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General NPI Number Information
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NPI Number | 1518567130
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Entity Type | Individual
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Provider Name | KATHERINE E SULLIVAN LMFT
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Gender | Female
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Dates
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Enumeration Date | 11/01/2020
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 2550 TIENDA PL
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City | ARROYO GRANDE
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State | CA
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Zip | 93420-9611
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Country | US
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Telephone | 714-580-4309
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Fax |
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Provider Business Mailing Address
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Address Line | 791 PRICE ST # 207
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City | PISMO BEACH
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State | CA
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Zip | 93449-2529
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Country | US
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Telephone | 714-580-4309
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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 | 132619
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License Number State | CA
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