Individual
MISTY SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED
Contact information
Practice address
1512 BAXTER AVE, LOUISVILLE, KY 40205-1009
(502) 262-2887
Mailing address
8206 HIGHVIEW CT, CRESTWOOD, KY 40014-8105
(502) 794-2965
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
166372
KY
Other
Enumeration date
01/03/2013
Last updated
01/30/2017
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