Active NPI
Camille Sullivan
- Mental Health Counselor
- Sandy, UT
National Provider Identifier
1053840140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 79071956004
- Practice address
- 8686 S 1300 E
Sandy, UT 84094-1947 - Phone
- (801) 709-0748
- NPI assigned
- Jun 12, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 79071956004 | UT | Primary |
Addresses
Primary practice location
8686 S 1300 E
Sandy, UT 84094-1947
Mailing address
8686 S 1300 E
Sandy, UT 84094-1947
Phone (801) 750-9090
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 26-4573566 | Medicaid | UT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 79071956004 | UT | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560211200000",
"number": "1053840140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8686 S 1300 E",
"city": "SANDY",
"state": "UT",
"postal_code": "840941947",
"telephone_number": "801-750-9090"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8686 S 1300 E",
"city": "SANDY",
"state": "UT",
"postal_code": "840941947",
"telephone_number": "801-709-0748"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "CAMILLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-12",
"last_updated": "2019-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "UT",
"license": "79071956004",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "26-4573566",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sandy, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.