Provider Demographics
NPI:1215548748
Name:GABRIELLE SULLIVAN LLC
Entity Type:Organization
Organization Name:GABRIELLE SULLIVAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, LIMHP, CMSW
Authorized Official - Phone:402-995-9277
Mailing Address - Street 1:2900 S 70TH ST STE 160
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-3733
Mailing Address - Country:US
Mailing Address - Phone:402-995-9277
Mailing Address - Fax:402-477-8284
Practice Address - Street 1:2900 S 70TH ST STE 160
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-3733
Practice Address - Country:US
Practice Address - Phone:402-995-9277
Practice Address - Fax:402-477-8284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-10
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty