Provider Demographics
NPI:1942457353
Name:SULLIVAN, NEAL JARVIS (LMFT)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:JARVIS
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 S SARATOGA DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-8106
Mailing Address - Country:US
Mailing Address - Phone:435-881-3771
Mailing Address - Fax:
Practice Address - Street 1:949 S SARATOGA DR
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-8106
Practice Address - Country:US
Practice Address - Phone:435-881-3771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8836139-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist