Provider Demographics
NPI:1215143706
Name:SULLIVAN, MICHELE MARIE (MS, LMFT, CMHS)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:MARIE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MS, LMFT, CMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2470 WESTLAKE AVE N STE 104
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2282
Mailing Address - Country:US
Mailing Address - Phone:206-717-8135
Mailing Address - Fax:206-717-8137
Practice Address - Street 1:2470 WESTLAKE AVE N STE 104
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2282
Practice Address - Country:US
Practice Address - Phone:206-717-8135
Practice Address - Fax:206-717-8137
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2022-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60447489106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist