Provider Demographics
NPI:1427289347
Name:SULLIVAN, PAUL MICHAEL (LPC)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:MICHAEL
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5397 HOWARD RD
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8815
Mailing Address - Country:US
Mailing Address - Phone:231-225-9030
Mailing Address - Fax:231-225-9026
Practice Address - Street 1:5397 HOWARD RD
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8815
Practice Address - Country:US
Practice Address - Phone:231-225-9030
Practice Address - Fax:231-225-9026
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009216101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional