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NPI Code Detail

MEDICARE: KATHLEEN SCARLETT SULLIVAN MFT

MEDICARE: KATHLEEN SCARLETT SULLIVAN MFT
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 Therapist49153CA

General Provider Information

NPI Number : 1790938694
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN SCARLETT SULLIVAN MFT
Provider Business Mailing Address
First Line : PO BOX 132
Second Line :
City : CEDAR RIDGE
State : CA
Zip : 95924-0132
Country : US
Telephone Number : 530-265-1720
Fax Number :
Provider Business Practice Location Address
First Line : 4212 MISSOURI FLAT RD
Second Line :
City : PLACERVILLE
State : CA
Zip : 95667-6269
Country : US
Telephone Number : 530-621-7700
Fax Number : 530-621-7713
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2008
Last Update Date : 01/23/2026

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