Mary Irene Sullivan, LPCC LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2021009968 Issued in MO

Practice address

11 Mabry Rd
Bellflower, MO 63333-2303

Phone

(715) 426-9877

NPI assigned

Apr 8, 2009

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MO, OR, WA, MN4 enrollments

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 4

Specialty

Mental Health Counselor

Education

Other, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Encounter Telehealth IncGroup PAC ID 9931348307, 20 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Encounter Telehealth, Inc

  • Multi-Specialty Clinic/Center
  • Omaha, NE
  • NPI 1922342195

  MN, MO, OR, WA

  Medicare reassignment Care Compare group NPD
• Ah Addiction Care PC

  • Addiction Medicine (Family Medicine) Physician
  • Redwood City, CA
  • NPI 1295516128

  OR

  Medicare reassignment NPD
• Sondermind Provider Network LLC

  • Clinical Social Worker
  • Denver, CO
  • NPI 1760854442

  MO, Professional

  Medicare reassignment NPD
• Sondermind, P.a.

  • Clinical Social Worker
  • Wichita, KS
  • NPI 1710647581

  MN, OR, WA

  Medicare reassignment NPD
• Ah Addiction Care of California PC

  • Addiction Medicine (Family Medicine) Physician
  • Sacramento, CA
  • NPI 1144055302
  NPD (past)

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

{
    "created_epoch": "1239148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687132800000",
    "number": "1295978153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 MABRY RD",
            "city": "BELLFLOWER",
            "state": "MO",
            "postal_code": "633332303",
            "telephone_number": "715-426-8777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 MABRY RD",
            "city": "BELLFLOWER",
            "state": "MO",
            "postal_code": "633332303",
            "telephone_number": "715-426-9877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MARY",
        "middle_name": "IRENE",
        "name_prefix": "Ms.",
        "credential": "LPCC LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-04-08",
        "last_updated": "2023-06-19",
        "certification_date": "2023-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "00181",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2021009968",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED PROFESSIONAL COUNSELOR",
            "identifier": "2021009968",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF MINNESOTA BOARD OF BEHAVIORAL HEALTH AND THERAPY",
            "identifier": "CC00181",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joshua Robert Lucas, EP-C

• Professional Counselor in Bellflower, MO
• Providers in Bellflower, MO by specialty
• Professional Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2023; 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.