Provider Demographics
NPI:1417703075
Name:SULLIVAN, KASSANDRA PETR (LMFT-A)
Entity type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:PETR
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LMFT-A
Other - Prefix:
Other - First Name:KASSANDRA
Other - Middle Name:JEANNE
Other - Last Name:PETR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1616 EGAN ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2737
Mailing Address - Country:US
Mailing Address - Phone:940-395-9279
Mailing Address - Fax:
Practice Address - Street 1:1722 KELLER PKWY
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3749
Practice Address - Country:US
Practice Address - Phone:682-382-2254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205489106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist