Provider Demographics
NPI:1386934230
Name:SULLIVAN, LINDSAY LIBBY
Entity type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:LIBBY
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S ALMA DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3771
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:203 S ALMA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3771
Practice Address - Country:US
Practice Address - Phone:207-590-6837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64886101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional