Provider Demographics
NPI:1437435534
Name:SULLIVAN, LISA OTERO (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:OTERO
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4609 W TENNYSON AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-6517
Mailing Address - Country:US
Mailing Address - Phone:813-376-9700
Mailing Address - Fax:
Practice Address - Street 1:205 S HOOVER BLVD STE 204
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3533
Practice Address - Country:US
Practice Address - Phone:813-376-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health