Melinda Baskin Sullivan, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH10362 Issued in FL

Practice address

910 S. 8TH Street, Suite 124
Fernandina Beach, FL 32034-2250

Phone

(904) 557-1006

NPI assigned

Oct 4, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Martha M Sullivan Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1286150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519257600000",
    "number": "1033428461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1012 OCEANVIEW CT",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320342250",
            "telephone_number": "904-557-1006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 S. 8TH STREET, SUITE 124",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320342250",
            "telephone_number": "904-557-1006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MELINDA",
        "middle_name": "BASKIN",
        "name_prefix": "Mrs.",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-10-04",
        "last_updated": "2018-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH10362",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12196399",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002775800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARTHA",
            "last_name": "SULLIVAN",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Mental Health Counselor in Fernandina Beach, FL
• Providers in Fernandina Beach, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2018; 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.