Individual
MR. BRUCE WAYNE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
450 E PASS RD, STE. 3, GULFPORT, MS 39507-3212
(228) 604-0099
(228) 604-2001
Mailing address
450 E PASS RD, STE. 3, GULFPORT, MS 39507-3212
(228) 604-0099
(228) 604-2001
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0727
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPC
MENTAL HEALTH
MS
Enumeration date
01/24/2006
Last updated
07/08/2007
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