Active NPI
Brian Kenneth Sullivan, PSYD
- Clinical Psychologist
- Mt Pleasant, SC
National Provider Identifier
1497923023
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 622
- Practice address
- 250 Mathis Ferry Rd
Suite 101
Mt Pleasant, SC 29464-2988 - Phone
- (843) 971-5171
- Fax
- (843) 971-5178
- NPI assigned
- Feb 17, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 622 | SC | Primary |
Addresses
Primary practice location
250 Mathis Ferry Rd
Suite 101
Mt Pleasant, SC 29464-2988
Mailing address
250 Mathis Ferry Rd
Suite 101
Mt Pleasant, SC 29464-2988
Phone (843) 971-5171
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 |
|---|---|---|---|
| 622 | SC | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203206400000",
"number": "1497923023",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 MATHIS FERRY RD",
"address_2": "SUITE 101",
"city": "MT PLEASANT",
"state": "SC",
"postal_code": "294642988",
"telephone_number": "843-971-5171",
"fax_number": "843-971-5178"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "250 MATHIS FERRY RD",
"address_2": "SUITE 101",
"city": "MT PLEASANT",
"state": "SC",
"postal_code": "294642988",
"telephone_number": "843-971-5171",
"fax_number": "843-971-5178"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "BRIAN",
"middle_name": "KENNETH",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-02-17",
"last_updated": "2008-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "SC",
"license": "622",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mt Pleasant, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.