Provider Demographics
NPI:1669197943
Name:ADAM SULLIVAN LLC
Entity type:Organization
Organization Name:ADAM SULLIVAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:206-486-5642
Mailing Address - Street 1:240 S SUNNYSIDE AVE UNIT 187
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-4007
Mailing Address - Country:US
Mailing Address - Phone:206-486-5642
Mailing Address - Fax:206-338-0639
Practice Address - Street 1:9 LAKE BELLEVUE DR STE 217
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2454
Practice Address - Country:US
Practice Address - Phone:206-486-5642
Practice Address - Fax:206-338-0639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty