Individual
TAYLOR NICHOLE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1600 JASON MAXWELL BLVD, LEWISBURG, TN 37091-2018
(931) 359-1197
Mailing address
2801 CRESTRIDGE DR, CENTERVILLE, TN 37033-5942
(931) 219-7794
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
16-23118
TN
Other
Enumeration date
04/21/2017
Last updated
04/21/2017
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