Provider Demographics
NPI:1407696438
Name:SULLIVAN, OLIVIA PEARL
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:PEARL
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 1:604 LOCUST ST APT 408
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-3741
Mailing Address - Country:US
Mailing Address - Phone:515-868-7321
Mailing Address - Fax:
Practice Address - Street 1:604 LOCUST ST APT 408
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-3741
Practice Address - Country:US
Practice Address - Phone:515-868-7321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health