Edison Sullivan, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

P2411018 Issued in AR

Practice address

3909 Highway 282
Van Buren, AR 72956-8718

Phone

(479) 242-1003

Fax

(501) 510-5917

NPI assigned

Dec 4, 2024

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

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

Mental Health Counselor

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Restaura Arkansas LLCGroup PAC ID 6800392895, 5 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.

• Restaura Arkansas LLC

  • Substance Abuse Rehabilitation Facility
  • Pine Bluff, AR
  • NPI 1104663889

  AR

  Medicare reassignment Care Compare group NPD
• Covenant Recovery Inc

  • Substance Abuse Rehabilitation Facility
  • Hot Springs, AR
  • NPI 1467196386

  AR

  Medicare reassignment NPD
• Lumina Revenue Cycle Management LLC

  • Substance Abuse Rehabilitation Facility
  • Van Buren, AR
  • NPI 1154894954

  AR

  Medicare reassignment NPD
• Recovery Resources LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Little Rock, AR
  • NPI 1659239564

  AR

  Medicare reassignment NPD

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

{
    "created_epoch": "1733270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733270400000",
    "number": "1346056413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3909 HIGHWAY 282",
            "city": "VAN BUREN",
            "state": "AR",
            "postal_code": "729568718",
            "telephone_number": "479-242-1003",
            "fax_number": "501-510-5917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3909 HIGHWAY 282",
            "city": "VAN BUREN",
            "state": "AR",
            "postal_code": "729568718",
            "telephone_number": "479-242-1003",
            "fax_number": "501-510-5917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "EDISON",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-12-04",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AR",
            "license": "P2411018",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Stephen, PTA
• Whitley Dawn Stewart, RN
• Kayla Stiles, PTA
• Skyler Elizabeth Storment
• Fritzie Suggs
• Summit Healthcare Inc.
• Superintendent of Van Buren School District 42
• Brianna Sweet
• Synergy Physical Therapy LLC
• T Bell Counseling, LLC

• Mental Health Counselor in Van Buren, AR
• Providers in Van Buren, AR by specialty
• Mental Health Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2024; 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.