Sullivan, Kevin A.

Sullivan, Kevin A. is an individual health care provider with primary practice located at 1500 W. Main St. Ste 300 Phoenix Counseling, Sun Prairie WI 53590. He recently has only one registered license in Behavioral Health & Social Service Providers / Counselor, which is considered as his primary health care specialty. Sullivan, Kevin A. can be contacted via phone (608) 825-6711.

Contact Information

Primary practice address
1500 W. Main St. Ste 300 Phoenix Counseling Sun Prairie WI 53590
Phone: (608) 825-6711
Fax: (608) 834-6499
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X 328 Wisconsin

Profile Details

NPI number 1457508996
LBN Legal business name Sullivan, Kevin A.
Credentials L.I.S.W.
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 27th, 2008
Last updated Aug 27th, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457508996 NPPES
Wisconsin MEDICAID 39-728100

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