Individual
MICHELLE P SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4700 NORTH LAS VEGAS BOULEVARD, MIKE O'CALLAGHAN FEDERAL MEDICAL CENTER, NELLIS AIR FORCE BASE, NV 89191-6601
(702) 653-3455
(702) 653-3398
Mailing address
4700 LAS VEGAS BLVD N, MIKE O'CALLAGHAN FEDERAL MEDICAL CENTER, NELLIS AFB, NV 89191-6600
(702) 653-3455
(702) 653-3398
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
CW014390
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SU 763420
HIGHMARK
PA
Enumeration date
11/02/2005
Last updated
03/10/2014
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