Provider Demographics
NPI:1194967786
Name:SULLIVAN, MARGARET GARAY (LCPC CADC/ATE MISAII)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:GARAY
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LCPC CADC/ATE MISAII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 W DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:MANTENO
Mailing Address - State:IL
Mailing Address - Zip Code:60950-1065
Mailing Address - Country:US
Mailing Address - Phone:815-468-3241
Mailing Address - Fax:815-468-5463
Practice Address - Street 1:411 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:MANTENO
Practice Address - State:IL
Practice Address - Zip Code:60950-1065
Practice Address - Country:US
Practice Address - Phone:815-468-3241
Practice Address - Fax:815-468-5463
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.002028101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL26-4527612OtherEIN