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General NPI Number Information
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NPI Number | 1730574237
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Entity Type | Organization
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Legal Business Name | TIMOTHY S. SULLIVAN, PH.D,, LLC
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Dates
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Enumeration Date | 04/01/2015
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Last Update Date | 04/01/2015
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Provider Practice Location Address
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Address Line | 3869 DARROW RD SUITE 104
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City | STOW
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State | OH
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Zip | 44224-2691
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Country | US
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Telephone | 713-820-4208
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Fax |
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Provider Business Mailing Address
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Address Line | 3869 DARROW RD SUITE 104
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City | STOW
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State | OH
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Zip | 44224-2691
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Country | US
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Telephone | 713-820-4208
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MR. TIMOTHY S SULLIVAN
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Credential | PH.D
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Telephone | 713-820-4208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 5645
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License Number State | OH
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