Provider Demographics
NPI:1528183159
Name:BERNARD J SULLIVAN PHD LLC
Entity Type:Organization
Organization Name:BERNARD J SULLIVAN PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:913-451-2843
Mailing Address - Street 1:10540 MARTY ST STE 155
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-2654
Mailing Address - Country:US
Mailing Address - Phone:913-451-2843
Mailing Address - Fax:913-383-1088
Practice Address - Street 1:10540 MARTY ST STE 155
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-2654
Practice Address - Country:US
Practice Address - Phone:913-451-2843
Practice Address - Fax:913-383-1088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLP-0436103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty