Provider Demographics
NPI:1912338526
Name:SULLIVAN, MEGGAN (LCSW)
Entity Type:Individual
Prefix:
First Name:MEGGAN
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 N 8TH PL STE 8
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-3203
Mailing Address - Country:US
Mailing Address - Phone:602-285-9696
Mailing Address - Fax:602-277-5930
Practice Address - Street 1:5050 N 8TH PL STE 8
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-3203
Practice Address - Country:US
Practice Address - Phone:602-285-9696
Practice Address - Fax:602-277-5930
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-13529101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health