Individual
ANTHONY MICHAEL SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
3225 INDEPENDENCE RD, CANON CITY, CO 81212-9380
(719) 275-2351
(719) 269-9386
Mailing address
3225 INDEPENDENCE RD, CANON CITY, CO 81212-9380
(719) 275-2351
(719) 269-9386
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
2778
CO
103T00000X
Psychologist
—
—
103TC0700X
Clinical Psychologist
Primary
3490
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
26350246
—
CO
Enumeration date
03/12/2007
Last updated
07/29/2020
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