Provider Demographics
NPI:1841440799
Name:SULLIVAN, KELLI ANN (MFT)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:ANN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:ANN
Other - Last Name:FITZGERALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:510 STATE STREET SUITE 270
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101
Mailing Address - Country:US
Mailing Address - Phone:805-252-5034
Mailing Address - Fax:805-564-2486
Practice Address - Street 1:510 STATE STREET SUITE 270
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101
Practice Address - Country:US
Practice Address - Phone:805-252-5034
Practice Address - Fax:805-564-2486
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT#44932106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist