Individual
DR. JILLIAN E SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D., HSPP
Contact information
Practice address
3000 S STATE ROAD 135, SUITE 230, GREENWOOD, IN 46143-9607
(317) 535-0728
Mailing address
6626 E 75TH STREET, SUITE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
20042704A
IN
103TC1900X
Counseling Psychologist
20042704A
IN
103TH0004X
Health Psychologist
Primary
20042704A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000850729
ANTHEM BCBS
IN
01
—
P01569147
RR MEDICARE
IN
Enumeration date
11/20/2013
Last updated
11/27/2023
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