Provider Demographics
NPI:1013100429
Name:SULLIVAN, COLLEEN ANNE (MED LMHC)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:ANNE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MED LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BLUE WATER DR
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-6103
Mailing Address - Country:US
Mailing Address - Phone:786-659-6571
Mailing Address - Fax:
Practice Address - Street 1:1217 WHITE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-3367
Practice Address - Country:US
Practice Address - Phone:305-497-7335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2019-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
FLMH13982101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor