Provider Demographics
NPI:1528431079
Name:SULLIVAN COUNSELING GROUP LLC
Entity type:Organization
Organization Name:SULLIVAN COUNSELING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLEARY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:260-451-2500
Mailing Address - Street 1:10311 DAWSON CREEK BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825
Mailing Address - Country:US
Mailing Address - Phone:260-451-2500
Mailing Address - Fax:260-451-2501
Practice Address - Street 1:10311 DAWSONS CREEK BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1913
Practice Address - Country:US
Practice Address - Phone:260-451-2500
Practice Address - Fax:260-451-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty