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NPI Code Detail

MEDICARE: MARILEE SULLIVAN

MEDICARE: MARILEE SULLIVAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFC 16080CA

General Provider Information

NPI Number : 1003926155
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARILEE SULLIVAN
Provider Business Mailing Address
First Line : 6147 SUTTER AVE
Second Line :
City : CARMICHAEL
State : CA
Zip : 95608-2738
Country : US
Telephone Number : 916-971-7640
Fax Number : 916-971-5711
Provider Business Practice Location Address
First Line : 6147 SUTTER AVE
Second Line :
City : CARMICHAEL
State : CA
Zip : 95608-2738
Country : US
Telephone Number : 916-971-7640
Fax Number : 916-971-5711
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 07/08/2007

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Directions to “ MARILEE SULLIVAN ” Practice Location

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