Provider Demographics
NPI:1811307150
Name:SULLIVAN, AUBREY ROSS OBRADOVICH (M ED)
Entity type:Individual
Prefix:MRS
First Name:AUBREY
Middle Name:ROSS OBRADOVICH
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 EASTERN PKWY STE 3364
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1415
Mailing Address - Country:US
Mailing Address - Phone:502-813-8280
Mailing Address - Fax:502-473-1334
Practice Address - Street 1:1169 EASTERN PKWY
Practice Address - Street 2:SUITE 3364
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1417
Practice Address - Country:US
Practice Address - Phone:502-813-8280
Practice Address - Fax:502-473-1334
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY127353101YP2500X
KYKY-1738101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor