Sullivan, Tanita Shanta

Sullivan, Tanita Shanta is an sole proprietor health care provider with primary practice located at 13985 Broken Arrow Dr , Willis TX 77378-4323. She recently has 4 registered licenses in different health care specialties including Residential Treatment Facilities / Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities, Residential Treatment Facilities / Residential Treatment Facility, Physical Disabilities, Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities, Residential Treatment Facilities / Substance Abuse Rehabilitation Facility. Residential Treatment Facilities / Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities is her primary health care specialty. Sullivan, Tanita Shanta can be contacted via phone (936) 856-6136.

Contact Information

Primary practice address
13985 Broken Arrow Dr Willis TX 77378-4323
Phone: (936) 856-6136
Fax: (936) 856-7549
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Residential Treatment Facilities / Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 320600000X
Residential Treatment Facilities / Residential Treatment Facility, Physical Disabilities 320700000X
Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 320900000X
Residential Treatment Facilities / Substance Abuse Rehabilitation Facility 324500000X

Profile Details

NPI number 1659671147
LBN Legal business name Sullivan, Tanita Shanta
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 29th, 2010
Last updated Oct 29th, 2010 - about 15 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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