Provider Demographics
NPI:1750265369
Name:SULLIVAN, KIERAN (RBT)
Entity type:Individual
Prefix:
First Name:KIERAN
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:618 N HIGH SCHOOL RD STE A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-3697
Mailing Address - Country:US
Mailing Address - Phone:317-731-7777
Mailing Address - Fax:
Practice Address - Street 1:618 N HIGH SCHOOL RD STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-3697
Practice Address - Country:US
Practice Address - Phone:317-731-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-23-254604106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician