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NPI Code Detail

MEDICARE: LATASHA C SULLIVAN M.ED., LPCC

MEDICARE: LATASHA C SULLIVAN M.ED., LPCC
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
1101Y00000XCounselorE.1700170-SUPVOH
2101YM0800XMental Health CounselorE1700170OH

General Provider Information

NPI Number : 1164951547
Entity Type Code : Individual
Provider Name (Legal Business Name) : LATASHA C SULLIVAN M.ED., LPCC
Provider Business Mailing Address
First Line : 3000 ARLINGTON AVE STOP 1108
Second Line :
City : TOLEDO
State : OH
Zip : 43614-2595
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1425 STARR AVE
Second Line :
City : TOLEDO
State : OH
Zip : 43605-2456
Country : US
Telephone Number : 419-693-0631
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2017
Last Update Date : 02/04/2026

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