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NPI Code Detail

MEDICARE: MS. SHELLEY LYNN SULLIVAN LPC

MEDICARE:  MS. SHELLEY LYNN SULLIVAN  LPC
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 Counselor0965TX

General Provider Information

NPI Number : 1093837296
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHELLEY LYNN SULLIVAN LPC
Provider Business Mailing Address
First Line : 10647 LE MANS DR
Second Line :
City : DALLAS
State : TX
Zip : 75238-3639
Country : US
Telephone Number : 214-371-3669
Fax Number :
Provider Business Practice Location Address
First Line : 3330 S LANCASTER RD
Second Line :
City : DALLAS
State : TX
Zip : 75216-4531
Country : US
Telephone Number : 214-371-6639
Fax Number : 214-372-6199
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2007
Last Update Date : 07/08/2007

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Directions to “ MS. SHELLEY LYNN SULLIVAN LPC” Practice Location

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