Individual
MARY K SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
212 11TH ST S, LA CROSSE, WI 54601-4116
(608) 392-9555
(608) 392-9432
Mailing address
700 WEST AVE S, PHYSICIAN SERVICES DEPT, LA CROSSE, WI 54601-4783
(608) 392-4156
(608) 392-4156
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3331
WI
Other
Enumeration date
11/13/2006
Last updated
07/08/2007
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