Active NPI
Makenzie Sullivan
- Behavior Analyst
- Flower Mound, TX
National Provider Identifier
1194462465
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 21-185480
- Practice address
- 2612 Long Prairie Rd Ste B
Flower Mound, TX 75022-4981 - Phone
- (855) 782-7822
- NPI assigned
- May 17, 2022
- 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 |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 21-185480 | TX | Primary |
Addresses
Primary practice location
2612 Long Prairie Rd Ste B
Flower Mound, TX 75022-4981
Mailing address
13861 Raceway Dr Apt 533
Northlake, TX 76262-6555
Phone (918) 978-3198
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 |
|---|---|---|---|
| 21-185480 | TX | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652745600000",
"number": "1194462465",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13861 RACEWAY DR APT 533",
"city": "NORTHLAKE",
"state": "TX",
"postal_code": "762626555",
"telephone_number": "918-978-3198"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2612 LONG PRAIRIE RD STE B",
"city": "FLOWER MOUND",
"state": "TX",
"postal_code": "750224981",
"telephone_number": "855-782-7822"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "MAKENZIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-05-17",
"last_updated": "2022-05-17",
"certification_date": "2022-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "TX",
"license": "21-185480",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flower Mound, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 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.