Provider Demographics
NPI:1154167674
Name:SULLIVAN, LINDA MARIE (LMFT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 W PARK AVE # 7461
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-8111
Mailing Address - Country:US
Mailing Address - Phone:909-557-6574
Mailing Address - Fax:909-363-9202
Practice Address - Street 1:11870 PIERCE ST STE 150
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-6600
Practice Address - Country:US
Practice Address - Phone:909-557-6574
Practice Address - Fax:909-363-9202
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist