Provider Demographics
NPI:1255668034
Name:SULLIVAN, LAURA ANNE (LPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANNE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7935 E 57TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-8622
Mailing Address - Country:US
Mailing Address - Phone:918-809-5795
Mailing Address - Fax:
Practice Address - Street 1:7935 E 57TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-8622
Practice Address - Country:US
Practice Address - Phone:918-809-5795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3982101YP2500X
OKLPC05846101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional