Provider Demographics
NPI:1215181979
Name:SULLIVAN, LYNSEY D (ADC, LMFT)
Entity Type:Individual
Prefix:
First Name:LYNSEY
Middle Name:D
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:ADC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 BOONE AVE N
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55428-3636
Mailing Address - Country:US
Mailing Address - Phone:612-719-8374
Mailing Address - Fax:
Practice Address - Street 1:5555 BOONE AVE N
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55428-3636
Practice Address - Country:US
Practice Address - Phone:612-719-8374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302053101YA0400X
MN4123106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)