Provider Demographics
NPI:1073946083
Name:SULLIVAN, LEANNE (MA, LMHCA)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4227 S MERIDIAN
Mailing Address - Street 2:SUITE #C-576
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3603
Mailing Address - Country:US
Mailing Address - Phone:253-474-7188
Mailing Address - Fax:253-446-7137
Practice Address - Street 1:2832 S MERIDIAN
Practice Address - Street 2:SUITE 101
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-1447
Practice Address - Country:US
Practice Address - Phone:253-474-7188
Practice Address - Fax:253-446-7137
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60398056101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health