Tina Marie Sullivan

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

101697 Issued in IA

Practice address

500 Willow Ave Ste 305
Council Bluffs, IA 51503-0807

Phone

(712) 256-4420

Fax

(712) 256-4423

NPI assigned

Oct 29, 2020

Sex

Female

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 IA

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, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Family Connections IncGroup PAC ID 9234550419, 15 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.

• Family Connections, Inc

  • Case Management Agency
  • Council Bluffs, IA
  • NPI 1740357300
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1603929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664928000000",
    "number": "1447850342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 N 16TH ST STE K",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515010109",
            "telephone_number": "712-256-4420",
            "fax_number": "712-256-4423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 WILLOW AVE STE 305",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515030807",
            "telephone_number": "712-256-4420",
            "fax_number": "712-256-4423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "TINA",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-29",
        "last_updated": "2022-10-05",
        "certification_date": "2022-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IA",
            "license": "101697",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tony Douglas Stuntz, D.D.S.
• Wendell R. Stuntz, DDS
• Carey Stutzman
• Kaylee Stutzman
• Amber Dawn Sulley
• Pranith Surabhi, M.D.
• Gabrielle Sutton
• Dustin Otto Svatos, DDS
• Josalynn N Swan, P.A.
• Megan Sweeney, PHARM D

• Mental Health Counselor in Council Bluffs, IA
• Providers in Council Bluffs, IA by specialty
• Mental Health Counselor in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2022; 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.