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General NPI Number Information
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NPI Number | 1962546325
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Entity Type | Organization
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Legal Business Name | MICHAEL C. SULLIVAN & ASSOCIATES
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2200 S MAIN ST SUITE 309
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City | LOMBARD
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State | IL
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Zip | 60148-5334
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Country | US
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Telephone | 630-705-0067
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Fax | 630-705-0473
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Provider Business Mailing Address
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Address Line | 2200 S MAIN ST SUITE 309
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City | LOMBARD
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State | IL
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Zip | 60148-5334
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Country | US
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Telephone | 630-705-0067
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Fax | 630-705-0473
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Authorized Official
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Title or Position | COUNSELOR
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Name | MR. MICHAEL CHARLES SULLIVAN
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Credential | LCPC,CADC
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Telephone | 630-705-0067
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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 | 180-00004412
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License Number State | IL
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