Provider Demographics
NPI:1457828535
Name:SULLIVAN, BRITTANY N
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:N
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 BUGSCUFFLE RD
Mailing Address - Street 2:
Mailing Address - City:LAVACA
Mailing Address - State:AR
Mailing Address - Zip Code:72941-6035
Mailing Address - Country:US
Mailing Address - Phone:479-462-3340
Mailing Address - Fax:
Practice Address - Street 1:7701 S ZERO ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6644
Practice Address - Country:US
Practice Address - Phone:479-478-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR226897795Medicaid