Provider Demographics
NPI:1720565286
Name:SULLIVAN, TONALISHA MONIQUE
Entity Type:Individual
Prefix:
First Name:TONALISHA
Middle Name:MONIQUE
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 1:5730 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64130-3340
Mailing Address - Country:US
Mailing Address - Phone:913-940-0219
Mailing Address - Fax:
Practice Address - Street 1:5730 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64130-3340
Practice Address - Country:US
Practice Address - Phone:913-940-0219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities