Provider Demographics
NPI:1962546325
Name:MICHAEL C. SULLIVAN & ASSOCIATES
Entity type:Organization
Organization Name:MICHAEL C. SULLIVAN & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC,CADC
Authorized Official - Phone:630-705-0067
Mailing Address - Street 1:2200 S MAIN ST
Mailing Address - Street 2:SUITE 309
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5334
Mailing Address - Country:US
Mailing Address - Phone:630-705-0067
Mailing Address - Fax:630-705-0473
Practice Address - Street 1:2200 S MAIN ST
Practice Address - Street 2:SUITE 309
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5334
Practice Address - Country:US
Practice Address - Phone:630-705-0067
Practice Address - Fax:630-705-0473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-00004412101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty