Organization
SULLIVAN MENTAL HEALTH SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JESSIE ELAINE SULLIVAN LCPC LMFT (OWNER/THERAPIST)
(208) 523-1558
Entity
Organization
Contact information
Practice address
660 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5299
(208) 523-1558
(208) 529-4788
Mailing address
660 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5299
(208) 523-1558
(208) 529-4788
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
ID
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
ID
Other
Enumeration date
06/13/2011
Last updated
11/30/2011
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