| Bernard J Sullivan Phd Llc | |
|
10540 Marty St Ste 155 Overland Park KS 66212-2654 | |
| (913) 451-2843 | |
| (913) 383-1088 |
| Full Name | Bernard J Sullivan Phd Llc |
|---|---|
| Speciality | Psychologist |
| Location | 10540 Marty St Ste 155, Overland Park, Kansas |
| Authorized Official Name and Position | Bernard John Sullivan (MEMBER) |
| Authorized Official Contact | 9134512843 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bernard J Sullivan Phd Llc 10540 Marty St Ste 155 Overland Park KS 66212-2654 Ph: (913) 451-2843 | Bernard J Sullivan Phd Llc 10540 Marty St Ste 155 Overland Park KS 66212-2654 Ph: (913) 451-2843 |
| NPI Number | 1528183159 |
|---|---|
| Provider Enumeration Date | 03/20/2007 |
| Last Update Date | 12/29/2010 |
| Medicare PECOS PAC ID | 0547369431 |
|---|---|
| Medicare Enrollment ID | O20070618000266 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528183159 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | LP-0436 (Kansas) | Primary |
| Provider Name | Bernard J Sullivan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1528184306 PECOS PAC ID: 6608866678 Enrollment ID: I20040513000477 |
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