Sean Alyston Sullivan, CASE MANAGER

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

2600 Cordova St
Anchorage, AK 99503-2745

Phone

(907) 279-9640

NPI assigned

Oct 2, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 2

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.

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    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648684800000",
    "number": "1194366070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 CORDOVA ST",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995032745",
            "telephone_number": "907-887-1045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 CORDOVA ST",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995032745",
            "telephone_number": "907-279-9640"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3600 San Jeronimo Dr",
            "address_purpose": "LOCATION",
            "city": "Anchorage",
            "state": "AK",
            "postal_code": "995082870",
            "country_code": "US",
            "telephone_number": "907-887-1045",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1645 Mountainman Loop",
            "address_purpose": "LOCATION",
            "city": "Anchorage",
            "state": "AK",
            "postal_code": "995071975",
            "country_code": "US",
            "telephone_number": "907-887-1045",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "SEAN",
        "middle_name": "ALYSTON",
        "credential": "CASE MANAGER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-10-02",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "AK",
            "license": "1194366070",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "AK",
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1194366070",
            "state": "AK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "yes",
            "affiliation": "N",
            "address_1": "1645 Mountainman Loop",
            "city": "Anchorage",
            "state": "AK",
            "country_code": "US",
            "postal_code": "995071975",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "No",
            "affiliation": "N",
            "address_1": "1645 Mountainman Loop",
            "city": "Anchorage",
            "state": "AK",
            "country_code": "US",
            "postal_code": "995071975",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lillian Marie Sullivan, LMT
• Mireille Lissette Sullivan
• Paige Ann Sullivan, PMHNP-BC
• Patrick Sullivan II, LMT
• Patrick L Sullivan
• Heather R Sulte, D.D.S., M.S.
• Ivo Sume
• Cornelio Sumera
• Rebekah M Summer, RD
• Summerfield Caring Hands LLC

• Addiction (Substance Use Disorder) Counselor in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Addiction (Substance Use Disorder) Counselor in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2022; 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.