Individual
PAULA A SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1002 WISHARD BLVD STE 2120, INDIANAPOLIS, IN 46202-2872
(317) 944-8162
(317) 944-9760
Mailing address
PO BOX 1026, INDIANAPOLIS, IN 46206-1026
(317) 777-6435
(317) 777-6644
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
20040129
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100218710
—
IN
Enumeration date
08/17/2006
Last updated
11/20/2020
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