Provider Demographics
NPI:1669826848
Name:SULLIVAN, DEBI
Entity Type:Individual
Prefix:
First Name:DEBI
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 S PALM AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4808
Mailing Address - Country:US
Mailing Address - Phone:951-285-5063
Mailing Address - Fax:
Practice Address - Street 1:464 S PALM AVE STE D
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4808
Practice Address - Country:US
Practice Address - Phone:951-247-6542
Practice Address - Fax:951-247-6959
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA87827106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist