Kelly Ann Sullivan, M.A., M.F.T.

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

49023 Issued in CA

Practice address

9939 Hibert St
Ste. 108
San Diego, CA 92131-1029

Phone

(619) 733-3655

Fax

(858) 578-3800

NPI assigned

Nov 26, 2006

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

Enrolled in CA

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

Specialty

Marriage and Family Therapist

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1164499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319673600000",
    "number": "1235205022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9939 HIBERT ST",
            "address_2": "STE. 108",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921311029",
            "telephone_number": "619-733-3655",
            "fax_number": "858-578-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9939 HIBERT ST",
            "address_2": "STE. 108",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921311029",
            "telephone_number": "619-733-3655",
            "fax_number": "858-578-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "M.A., M.F.T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-26",
        "last_updated": "2011-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "49023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeff Allen Sullivan, PH.D., ATC
• John Philip Sullivan, M.D
• Julie Marie Sullivan, M.D.
• Kathy Rebecca Sullivan, IDC
• Keith Patrick Sullivan
• Kevin Brian Sullivan, DO
• Kyle Kathleen Sullivan
• Leigh Sullivan
• Liane Sullivan, MA, MFS
• Maggie Sullivan

• Marriage & Family Therapist in San Diego, CA
• Providers in San Diego, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2011; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.