Provider Demographics
NPI:1275820680
Name:THE SULLIVAN CENTER FOR CHILDREN
Entity Type:Organization
Organization Name:THE SULLIVAN CENTER FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:MELLISSA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-271-1186
Mailing Address - Street 1:3443 W SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3249
Mailing Address - Country:US
Mailing Address - Phone:559-271-1186
Mailing Address - Fax:559-271-8041
Practice Address - Street 1:3443 WEST SHAW AVENUE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711
Practice Address - Country:US
Practice Address - Phone:559-271-1186
Practice Address - Fax:559-271-8041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103PC0700X103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSB 35913OtherPRIVATE PAY INSURANCE