NPIMap

Organization Active NPI

Sullivan, Nolan & Associates, P.C.

  • Clinical Psychologist
  • Ann Arbor, MI
National Provider Identifier
1235285487
Registry record updated Apr 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6301006105 Issued in MI
Legal business name
SULLIVAN, NOLAN & ASSOCIATES, P.C.
Practice address
3700 W Liberty Rd
Ann Arbor, MI 48103-9056
Phone
(734) 426-0032
Fax
(734) 426-0034
NPI assigned
Jan 28, 2007
Last updated
Apr 2, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2021

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

Authorized official

Name
Dr. Kristina Rask, PH.D.NPI 1538118427
Title
President
Phone
(734) 426-0032

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 6301006105 MI Primary

Addresses

Primary practice location

3700 W Liberty Rd
Ann Arbor, MI 48103-9056

Mailing address

3700 W Liberty Rd
Ann Arbor, MI 48103-9056
Phone (734) 426-0032

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210510002458 MI Part B Supplier - Clinic/Group Practice 2769891464 Receives reassigned benefits from 8 practitioners
Practice locations: Ann Arbor, MI

National Provider Directory

National Provider Directory

Locations

3700 W Liberty Rd
Ann Arbor, MI 48103
Phone (734) 426-0032

6360 Jackson Rd
Ste M
Ann Arbor, MI 48103
Phone (734) 558-3575

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1169942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617321600000",
    "number": "1235285487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3700 W LIBERTY RD",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481039056",
            "telephone_number": "734-426-0032",
            "fax_number": "734-426-0034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 W LIBERTY RD",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481039056",
            "telephone_number": "734-426-0032",
            "fax_number": "734-426-0034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SULLIVAN, NOLAN & ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-28",
        "last_updated": "2021-04-02",
        "certification_date": "2021-04-02",
        "status": "A",
        "authorized_official_last_name": "RASK",
        "authorized_official_first_name": "KRISTINA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "734-426-0032",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301006105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.