Provider Demographics
NPI:1518575356
Name:SULLIVAN, LINDSY (LSW)
Entity Type:Individual
Prefix:
First Name:LINDSY
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 KIETZKE LN STE H182
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-5042
Mailing Address - Country:US
Mailing Address - Phone:775-825-9995
Mailing Address - Fax:
Practice Address - Street 1:4600 KIETZKE LN STE H182
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-5042
Practice Address - Country:US
Practice Address - Phone:758-259-9957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8207-S104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker