Provider Demographics
NPI:1639395486
Name:SULLIMAN, JAMES ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:SULLIMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 RIDGEMONT DR
Mailing Address - Street 2:APARTMENT 1915
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-2780
Mailing Address - Country:US
Mailing Address - Phone:325-692-4976
Mailing Address - Fax:
Practice Address - Street 1:1317 N 8TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-4145
Practice Address - Country:US
Practice Address - Phone:325-672-5683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8827101YP2500X
TX001590-001605106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
82442LOtherBLUE CROSS BLUE SHIELD