Provider Demographics
NPI:1912128836
Name:SULLIVAN, MAUREEN A (PHD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:A
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 N MURRAY HALL
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74078-3064
Mailing Address - Country:US
Mailing Address - Phone:405-269-5631
Mailing Address - Fax:405-744-2826
Practice Address - Street 1:118 N MURRAY HALL
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74078-3064
Practice Address - Country:US
Practice Address - Phone:405-269-5631
Practice Address - Fax:405-744-2826
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK717103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist