Provider Demographics
NPI:1043285612
Name:SULLIVAN, MICHAEL PATRICK (BA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PATRICK
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:BA
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3449 REDWOOD AVENUE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225
Mailing Address - Country:US
Mailing Address - Phone:360-756-1366
Mailing Address - Fax:
Practice Address - Street 1:609 NORTH SHORE DRIVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-4414
Practice Address - Country:US
Practice Address - Phone:360-676-6000
Practice Address - Fax:360-676-6006
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health