Individual
TINA MARIE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
500 WILLOW AVE STE 305, COUNCIL BLUFFS, IA 51503-0807
(712) 256-4420
(712) 256-4423
Mailing address
1720 N 16TH ST STE K, COUNCIL BLUFFS, IA 51501-0109
(712) 256-4420
(712) 256-4423
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
101697
IA
Other
Enumeration date
10/29/2020
Last updated
10/05/2022
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