Marisa Sullivan, LCPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

180007151 Issued in IL

Practice address

3325 N Arlington Heights Rd
Suite 400B
Arlington Heights, IL 60004-1582

Phone

(847) 749-0514

Fax

(847) 749-2995

NPI assigned

Jan 6, 2016

Last updated

Jan 6, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Barnes and Klatt PCGroup PAC ID 1052369865, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Barnes & Klatt PC

  • Clinical Psychologist
  • Mount Prospect, IL
  • NPI 1659425361
  Medicare reassignment Care Compare group
• Clinical Care Consultants PC

  • Professional Counselor
  • Arlington Heights, IL
  • NPI 1043524903
  NPD (past)
• Rosenberg & Associates Professional Counselors LTC

  • Community/Behavioral Health Agency
  • Arlington Heights, IL
  • NPI 1104110758
  NPD (past)

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

{
    "created_epoch": "1452038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452038400000",
    "number": "1609232701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3325 N ARLINGTON HEIGHTS RD",
            "address_2": "SUITE 400B",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600041582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3325 N ARLINGTON HEIGHTS RD",
            "address_2": "SUITE 400B",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600041582",
            "telephone_number": "847-749-0514",
            "fax_number": "847-749-2995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MARISA",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-06",
        "last_updated": "2016-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "180007151",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180007151",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carol Sulatycke, M.S. ED.
• Azza Suleiman, M.D.
• Manal Suleiman
• Mackenzie Marie Sullivan, MS, LMFT
• Mallory Sullivan
• Munawar Sultana, M.D
• Nina M Sultanian, MD
• Seta Siran Sultanian, M.D.
• Summers Pediatrics, S.C.
• Gregory Allen Summers, M.D.

• Mental Health Counselor in Arlington Heights, IL
• Providers in Arlington Heights, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2016; 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.