Jessie Elaine Sullivan, LCPC,LMFT

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LCPC-119 Issued in ID

Practice address

660 S Woodruff Ave
Idaho Falls, ID 83401-5299

Phone

(208) 523-1558

Fax

(208) 529-4788

NPI assigned

Jun 25, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sullivan Mental Health Services LLC

  • Adult Mental Health Clinic/Center
  • Idaho Falls, ID
  • NPI 1003101577
  NPD (past) Authorized official

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

{
    "created_epoch": "1214352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308182400000",
    "number": "1063674786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3785 COLTS GLEN LN",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048353",
            "telephone_number": "208-524-2411"
        },
        {
            "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": {
        "last_name": "SULLIVAN",
        "first_name": "JESSIE",
        "middle_name": "ELAINE",
        "name_prefix": "Ms.",
        "credential": "LCPC,LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-06-25",
        "last_updated": "2011-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "ID",
            "license": "LCPC-119",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "ID",
            "license": "LMFT-2963",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renae Michelle Suarez, LMSW
• Emily Sucher, RDN
• Keaton Jake Suitter, LPC
• Rebecca T Sulik
• Sullivan Mental Health Services LLC
• Joshua Summers, DO
• Patti Joleen Summers, LPC
• Summit Eyecare PLLC
• Summit Health Professionals
• Summit Orthopaedics Management and Consulting, LLC

• Mental Health Counselor in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Mental Health Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.