Provider Demographics
NPI:1760250260
Name:SULLIVAN, AMY ELIZABETH (LPC)
Entity Type:Individual
Prefix:MISS
First Name:AMY
Middle Name:ELIZABETH
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2338 HARVEY MITCHELL PKWY S APT 7102
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5143
Mailing Address - Country:US
Mailing Address - Phone:817-705-5042
Mailing Address - Fax:
Practice Address - Street 1:2423 EARL RUDDER FWY S STE 300
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6090
Practice Address - Country:US
Practice Address - Phone:979-221-2257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86498101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health