Provider Demographics
NPI:1831248491
Name:SULLIVAN, PIPER (MA, LPC)
Entity type:Individual
Prefix:
First Name:PIPER
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 W SHENANDOAH ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-2566
Mailing Address - Country:US
Mailing Address - Phone:541-580-0525
Mailing Address - Fax:541-672-4272
Practice Address - Street 1:517 W SHENANDOAH ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-2566
Practice Address - Country:US
Practice Address - Phone:541-580-0525
Practice Address - Fax:541-672-4272
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3182101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC3182OtherLPC - OREGON
OR500659547Medicaid
ORC3182OtherLPC - OREGON
NC6115147Medicaid