NPIMap

Organization Active NPI

Sullivan Mental Health Services LLC

  • Adult Mental Health Clinic/Center
  • Idaho Falls, ID
National Provider Identifier
1003101577
Registry record updated Nov 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
SULLIVAN MENTAL HEALTH SERVICES LLC
Practice address
660 S Woodruff Ave
Idaho Falls, ID 83401-5299
Phone
(208) 523-1558
Fax
(208) 529-4788
NPI assigned
Jun 13, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Jessie Elaine Sullivan, LCPC LMFTNPI 1063674786
Title
Owner/Therapist
Phone
(208) 523-1558

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X ID Primary
Adolescent and Children Mental Health Clinic/Center 261QM0855X ID

Addresses

Primary practice location

660 S Woodruff Ave
Idaho Falls, ID 83401-5299

Mailing address

660 S Woodruff Ave
Idaho Falls, ID 83401-5299
Phone (208) 523-1558

National Provider Directory

National Provider Directory

Locations

660 S Woodruff Ave
Idaho Falls, ID 83401
Phone (208) 523-1558

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1307923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322611200000",
    "number": "1003101577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834015299",
            "telephone_number": "208-523-1558",
            "fax_number": "208-529-4788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "660 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834015299",
            "telephone_number": "208-523-1558",
            "fax_number": "208-529-4788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SULLIVAN MENTAL HEALTH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-13",
        "last_updated": "2011-11-30",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "JESSIE",
        "authorized_official_middle_name": "ELAINE",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "208-523-1558",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCPC LMFT"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "ID",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "ID",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.