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NPI Code Detail

MEDICARE: MR. MICHAEL PATRICK SULLIVAN BA

MEDICARE: MR. MICHAEL PATRICK SULLIVAN BA
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1043285612
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL PATRICK SULLIVAN BA
Provider Business Mailing Address
First Line : 3449 REDWOOD AVENUE
Second Line : SUITE 5
City : BELLINGHAM
State : WA
Zip : 98225
Country : US
Telephone Number : 360-756-1366
Fax Number :
Provider Business Practice Location Address
First Line : 609 NORTH SHORE DRIVE
Second Line :
City : BELLINGHAM
State : WA
Zip : 98226-4414
Country : US
Telephone Number : 360-676-6000
Fax Number : 360-676-6006
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2006
Last Update Date : 09/01/2021

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