Provider Demographics
NPI:1306582697
Name:O'SULLIVAN, BRIAN (LMFT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:O'SULLIVAN
Suffix:
Gender:M
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:MARUNAKA B-301, 5-CHOME-26-16
Mailing Address - Street 2:
Mailing Address - City:GOYA, OKINAWA CITY
Mailing Address - State:OKINAWA
Mailing Address - Zip Code:9040021
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MARUNAKA B-301, 5-CHOME-26-16
Practice Address - Street 2:
Practice Address - City:GOYA, OKINAWA CITY
Practice Address - State:OKINAWA
Practice Address - Zip Code:9040021
Practice Address - Country:JP
Practice Address - Phone:559-343-1458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT122484106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist