Provider Demographics
NPI:1447483458
Name:SULLIVAN, AMANDA L (LMHP, CMSW)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:L
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LMHP, CMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 N COTNER BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2377
Mailing Address - Country:US
Mailing Address - Phone:402-937-9607
Mailing Address - Fax:
Practice Address - Street 1:770 N COTNER BLVD STE 330
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2377
Practice Address - Country:US
Practice Address - Phone:402-937-9607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4343101YM0800X
NE15281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE$$$$$$$$$Medicaid
NE97109OtherBCBS