Individual
RITA DE-HAAN SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D
Contact information
Practice address
201 W MAIN ST, SUITE 1B, MEDFORD, OR 97501-2744
(541) 944-5711
Mailing address
PO BOX 4152, MEDFORD, OR 97501-0154
(541) 944-5711
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
965
OR
Other
Enumeration date
11/01/2006
Last updated
05/11/2017
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