Active NPI
Tina Sullivan, APSW
- Mental Health Counselor
- De Pere, WI
National Provider Identifier
1447145255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 135534-121
- Practice address
- 3860 Monroe Rd
De Pere, WI 54115-8399 - Phone
- (920) 496-4700
- NPI assigned
- Jun 11, 2025
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 135534-121 | WI | |
| Mental Health Counselor | 101YM0800X | 135534-121 | WI | Primary |
Addresses
Primary practice location
3860 Monroe Rd
De Pere, WI 54115-8399
Mailing address
PO Box 19070
Green Bay, WI 54307-9070
Phone (920) 496-4700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100329015 | Medicaid | WI |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | tsullivan453574@ewd.direct.hshs.org | Direct |
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 |
|---|---|---|---|
| 135534-121 | WI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1749600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752105600000",
"number": "1447145255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 19070",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543079070",
"telephone_number": "920-496-4700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3860 MONROE RD",
"city": "DE PERE",
"state": "WI",
"postal_code": "541158399",
"telephone_number": "920-496-4700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "TINA",
"credential": "APSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-06-11",
"last_updated": "2025-07-10",
"certification_date": "2025-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "135534-121",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WI",
"license": "135534-121",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100329015",
"state": "WI"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "tsullivan453574@ewd.direct.hshs.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CDA/CCD/TXT",
"address_1": "3860 Monroe Rd",
"city": "DE Pere",
"state": "WI",
"country_code": "US",
"postal_code": "541158399",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in De Pere, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.