Individual
MS. MARY IRENE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC LPC
Contact information
Practice address
11 MABRY RD, BELLFLOWER, MO 63333-2303
(715) 426-9877
Mailing address
11 MABRY RD, BELLFLOWER, MO 63333-2303
(715) 426-8777
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
00181
MN
101YP2500X
Professional Counselor
Primary
2021009968
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021009968
LICENSED PROFESSIONAL COUNSELOR
MO
01
—
CC00181
STATE OF MINNESOTA BOARD OF BEHAVIORAL HEALTH AND THERAPY
MN
Enumeration date
04/08/2009
Last updated
06/19/2023
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