Provider Demographics
NPI:1154429298
Name:SULLIVAN, KAREN (MFT)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2378 MARITIME DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-3641
Mailing Address - Country:US
Mailing Address - Phone:916-267-0368
Mailing Address - Fax:916-226-6873
Practice Address - Street 1:2378 MARITIME DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-3641
Practice Address - Country:US
Practice Address - Phone:916-267-0368
Practice Address - Fax:916-226-6873
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41413106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist