Active NPI
Priscilla Jane Sullivan, MHP
- Counselor
- Mattoon, IL
National Provider Identifier
1164589826
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 750 Broadway Ave E
Mattoon, IL 61938-4610 - Phone
- (217) 238-5700
- Fax
- (217) 238-5767
- NPI assigned
- Jan 2, 2007
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | Primary |
Addresses
Primary practice location
750 Broadway Ave E
Mattoon, IL 61938-4610
Mailing address
750 Broadway Ave E
Mattoon, IL 61938-4610
Phone (217) 238-5700
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1237420800000",
"number": "1164589826",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "750 BROADWAY AVE E",
"city": "MATTOON",
"state": "IL",
"postal_code": "619384610",
"telephone_number": "217-238-5700",
"fax_number": "217-238-5767"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "750 BROADWAY AVE E",
"city": "MATTOON",
"state": "IL",
"postal_code": "619384610",
"telephone_number": "217-238-5700",
"fax_number": "217-238-5767"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "PRISCILLA",
"middle_name": "JANE",
"credential": "MHP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-02",
"last_updated": "2009-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mattoon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.