Individual
LAURA SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LMFT
Contact information
Practice address
18 S INDIANA ST, MOORESVILLE, IN 46158-1648
(317) 831-9764
(317) 831-9764
Mailing address
18 S INDIANA ST, MOORESVILLE, IN 46158-1648
(317) 831-9764
(317) 831-9764
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
35001383A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000238241
ANTHEM
IN
01
—
243733
VALUE OPTIONS
IN
01
—
SULLI-1977
COMPCARE
IN
Enumeration date
01/03/2007
Last updated
07/08/2007
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