Individual
KEITH ALAN SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5005 N PENNSYLVANIA AVE, 103, OKLAHOMA CITY, OK 73112-8886
(405) 753-4269
Mailing address
5005 N PENNSYLVANIA AVE, 103, OKLAHOMA CITY, OK 73112-8886
(405) 753-4269
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
77-0700929
OK
Other
Enumeration date
04/23/2010
Last updated
04/23/2010
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