Individual
TERI RAE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
7180 W 107TH ST, SUITE 20, OVERLAND PARK, KS 66212-2523
(913) 341-5700
(913) 341-5750
Mailing address
7180 W 107TH ST, SUITE 20, OVERLAND PARK, KS 66212-2523
(913) 341-5700
(913) 341-5750
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
KS0442
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SUS71097
—
KS
Enumeration date
06/12/2006
Last updated
01/17/2008
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