Provider Demographics
NPI:1114215266
Name:SULLIVAN, JEFFREY M (MS, LPC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:M
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 SAWDUST RD STE 1101
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2580
Mailing Address - Country:US
Mailing Address - Phone:940-372-0489
Mailing Address - Fax:
Practice Address - Street 1:2219 SAWDUST RD STE 1101
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380
Practice Address - Country:US
Practice Address - Phone:940-372-0489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66871101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional