Individual
MICHAEL SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
164 NW HAWTHORNE AVE, BEND, OR 97703-2918
(802) 595-9090
Mailing address
164 NW HAWTHORNE AVE, BEND, OR 97703-2918
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C6081
OR
Other
Enumeration date
03/07/2023
Last updated
07/22/2025
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