Provider Demographics
NPI:1083822175
Name:SULLIVAN, JULIE HARDESTY (LMFTT)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:HARDESTY
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LMFTT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 W 54TH TER
Mailing Address - Street 2:SUITE B
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2416
Mailing Address - Country:US
Mailing Address - Phone:913-236-4439
Mailing Address - Fax:
Practice Address - Street 1:4101 W 54TH TER
Practice Address - Street 2:SUITE A
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66205-2416
Practice Address - Country:US
Practice Address - Phone:913-710-0961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS863106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist