Provider Demographics
NPI:1629033279
Name:MERCHANT-SULLIVAN, LILLIAN (PHD LCPC)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:MERCHANT-SULLIVAN
Suffix:
Gender:F
Credentials:PHD LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N MAIN
Mailing Address - Street 2:SUITE L100
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611
Mailing Address - Country:US
Mailing Address - Phone:309-694-6462
Mailing Address - Fax:309-694-7812
Practice Address - Street 1:100 N MAIN
Practice Address - Street 2:SUITE L100
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611
Practice Address - Country:US
Practice Address - Phone:309-694-6462
Practice Address - Fax:309-694-7812
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health