MEDICARE: STEPHEN SULLIVAN LCPC

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	101YM0800X	Mental Health Counselor	178.016354	IL
2	101YM0800X	Mental Health Counselor	180.016569	IL
3	101YM0800X	Mental Health Counselor	178016354	IL
4	101YP2500X	Professional Counselor	180.016569	IL

General Provider Information

NPI Number	:	1801564554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN SULLIVAN LCPC

Provider Business Mailing Address
First Line	:	4800 N SCOTTSDALE RD STE 2500
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-7630
Country	:	US
Telephone Number	:	630-428-7890
Fax Number	:

Provider Business Practice Location Address
First Line	:	3976 N AVONDALE AVE FL 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-2900
Country	:	US
Telephone Number	:	312-319-4162
Fax Number	:

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

Provider Enumeration Date	:	08/30/2021
Last Update Date	:	05/20/2025

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