Individual
DR. BRYCE FREDERICK SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
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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