Tiffany Lynn Sullivan, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC007416 Issued in GA

Practice address

901 Pavilion CT
McDonough, GA 30253-6665

Phone

(678) 814-4375

Fax

(678) 490-2361

NPI assigned

Jul 25, 2012

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

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Mindful Realizations Counseling & Consulting LLC

  • Professional Counselor
  • McDonough, GA
  • NPI 1295164549
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1343174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548201600000",
    "number": "1093061285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 PAVILION CT",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302536665",
            "telephone_number": "678-814-4375",
            "fax_number": "678-490-2361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 PAVILION CT",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302536665",
            "telephone_number": "678-814-4375",
            "fax_number": "678-490-2361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "TIFFANY",
        "middle_name": "LYNN",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-25",
        "last_updated": "2019-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC007416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Subra, OT
• Successful Dreams Beliefs & Achievements, Inc
• Successful Dreams Beliefs & Achievements, Inc.
• John Sullivan, LCSW
• Kevin Sullivan, MS, LAT, ATC
• Brittany C Sumpter, DPM
• Superior Concierge Care,LLC
• Superior Healthcare Services, LLC
• Superior Private Homecare Agency
• Surgical Travelers Headquarters LLC

• Professional Counselor in McDonough, GA
• Providers in McDonough, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.