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Individual

KELLEY M SULLIVAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
166 HIGH POINT DR, LONGMONT, CO 80504-8540
(512) 905-0072
Mailing address
166 HIGH POINT DR, LONGMONT, CO 80504-8540
(512) 905-0072

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
50388
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
50388
LIC. CLINICAL SOCIAL WORK
TX
Enumeration date
03/22/2007
Last updated
10/17/2025
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