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General NPI Number Information
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NPI Number | 1861894537
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Entity Type | Individual
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Provider Name | KAREN S SULLIVAN MA, PLMHP, LADC
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Gender | Female
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Dates
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Enumeration Date | 09/24/2014
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 2112 W FAIDLEY AVE
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City | GRAND ISLAND
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State | NE
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Zip | 68803-4670
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Country | US
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Telephone | 83-398-5328
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Fax | 308-398-5404
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Provider Business Mailing Address
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Address Line | 7117 FARNAM ST STE 17
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City | OMAHA
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State | NE
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Zip | 68132-3319
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Country | US
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Telephone | 531-301-7817
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Fax | 402-885-7596
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1242
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License Number State | NE
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