NPIMap

Organization Active NPI

Sullivan Counseling

  • Clinical Social Worker
  • Fort Wayne, IN
National Provider Identifier
1487903159
Registry record updated Mar 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
34001106A Issued in IN
Legal business name
SULLIVAN COUNSELING
Practice address
10311 Dawsons Creek Blvd Ste E
Fort Wayne, IN 46825-1913
Phone
(260) 451-2500
Fax
(260) 451-2501
NPI assigned
Sep 10, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2015

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

Authorized official

Name
Dian K Sullivan, LCSW
Title
Owner
Phone
(260) 451-2500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X 34001106A IN Primary

Addresses

Primary practice location

10311 Dawsons Creek Blvd Ste E
Fort Wayne, IN 46825-1913

Mailing address

10311 Dawsons Creek Blvd Ste E
Fort Wayne, IN 46825-1913
Phone (260) 451-2500

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1347235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426204800000",
    "number": "1487903159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10311 DAWSONS CREEK BLVD STE E",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251913",
            "telephone_number": "260-451-2500",
            "fax_number": "260-451-2501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10311 DAWSONS CREEK BLVD STE E",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251913",
            "telephone_number": "260-451-2500",
            "fax_number": "260-451-2501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SULLIVAN COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-10",
        "last_updated": "2015-03-13",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "DIAN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "260-451-2500",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34001106A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.