Individual
DR. BRYCE FREDERICK SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
910 N MAIN ST, EDWARDSVILLE, IL 62025-1116
(618) 659-8787
Mailing address
516 N KANSAS ST, EDWARDSVILLE, IL 62025-1137
(618) 659-8787
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
2000159809
MO
103TC0700X
Clinical Psychologist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06032019
BCBS PPO
IL
01
—
691275
HEALTHLINK HMO & PPO
—
Enumeration date
11/10/2006
Last updated
07/08/2007
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