Individual
LYSHA A SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
130 S LINCOLN AVE, JEROME, ID 83338-2631
(208) 595-4950
Mailing address
130 S LINCOLN AVE, JEROME, ID 83338-2631
(208) 595-4950
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103K00000X
Behavior Analyst
—
—
106S00000X
Behavior Technician
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/13/2024
Last updated
11/13/2024
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