Individual
BRIAN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
44374 PALM ST, INDIO, CA 92201-3117
(760) 342-6616
Mailing address
44374 PALM ST, INDIO, CA 92201-3117
(760) 342-6616
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
07/20/2023
Last updated
07/20/2023
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