Provider Demographics
NPI:1558407916
Name:SULLIVAN, LYNNE E (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:E
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-6905
Mailing Address - Country:US
Mailing Address - Phone:701-253-3776
Mailing Address - Fax:701-253-3999
Practice Address - Street 1:2605 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-6905
Practice Address - Country:US
Practice Address - Phone:701-253-3776
Practice Address - Fax:701-253-3999
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDND 389103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist