Michael A Sullivan-Tibbs, LCSW, LCAC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34005914A Issued in IN

Practice address

1030 Jefferson Ave
Memphis, TN 38104-2127

Phone

(317) 748-8710

NPI assigned

Aug 30, 2010

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1283126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550102400000",
    "number": "1720394562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 LEBANON RD",
            "city": "MURFREESBORO",
            "state": "TN",
            "postal_code": "371291392",
            "telephone_number": "615-225-4729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 JEFFERSON AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381042127",
            "telephone_number": "317-748-8710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN-TIBBS",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "LCSW, LCAC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-08-30",
        "last_updated": "2019-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IN",
            "license": "87000061A",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34005914A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jecarta Bernadette Suggs, BLS
• Debra Mehuron Suiter, PH.D.
• Ali Y Suliman, MD, MSC
• Allison M. Sulkowski, M.A., CCC-SLP
• Sydney Claire Sullicant, OT
• Adrienne Claire Sullivan
• Anne Lorraine Self Sullivan, MD
• Catherine Brooke Sullivan, PHARM.D.
• Chuck Sullivan
• Courtney Sullivan

• Clinical Social Worker in Memphis, TN
• Providers in Memphis, TN by specialty
• Clinical Social Worker in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2019; 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.