MEDICARE: RACHEL 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
1	101YP2500X	Professional Counselor	6401013234	MI
2	101Y00000X	Counselor	6401013234	MI

General Provider Information

NPI Number	:	1427453430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL SULLIVAN LPC

Provider Business Mailing Address
First Line	:	53505 VAN DYKE AVE
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48316-1861
Country	:	US
Telephone Number	:	586-580-1752
Fax Number	:

Provider Business Practice Location Address
First Line	:	53505 VAN DYKE AVE
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48316-1861
Country	:	US
Telephone Number	:	586-580-1752
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2014
Last Update Date	:	05/21/2020

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