Provider Demographics
NPI:1245218114
Name:SULLIVAN, ANGELA ANN (MA)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:ANN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:ANN
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 301
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64013-2209
Mailing Address - Country:US
Mailing Address - Phone:816-229-2760
Mailing Address - Fax:
Practice Address - Street 1:710 W MAIN ST
Practice Address - Street 2:SUITE G
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-3722
Practice Address - Country:US
Practice Address - Phone:816-229-2760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-02
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002020608101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional