Provider Demographics
NPI:1083164248
Name:SULLIVAN, CAITLIN (LMFT)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 5TH AVE SW STE 101
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5483
Mailing Address - Country:US
Mailing Address - Phone:564-464-3418
Mailing Address - Fax:564-464-3489
Practice Address - Street 1:1020 5TH AVE SW STE 101
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5483
Practice Address - Country:US
Practice Address - Phone:564-464-3489
Practice Address - Fax:564-464-3489
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WALF60923314106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health