Active NPI
Amy Elizabeth Sullivan, LPC
- Mental Health Counselor
- College Station, TX
National Provider Identifier
1760250260
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 86498
- Practice address
- 2423 Earl Rudder Fwy S Ste 300
College Station, TX 77845-6090 - Phone
- (979) 221-2257
- NPI assigned
- Dec 13, 2023
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 86498 | TX | Primary |
Addresses
Primary practice location
2423 Earl Rudder Fwy S Ste 300
College Station, TX 77845-6090
Mailing address
2338 Harvey Mitchell Pkwy S Apt 7102
College Station, TX 77845-5143
Phone (817) 705-5042
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86498 | TX | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1702425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1702425600000",
"number": "1760250260",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2338 HARVEY MITCHELL PKWY S APT 7102",
"city": "COLLEGE STATION",
"state": "TX",
"postal_code": "778455143",
"telephone_number": "817-705-5042"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2423 EARL RUDDER FWY S STE 300",
"city": "COLLEGE STATION",
"state": "TX",
"postal_code": "778456090",
"telephone_number": "979-221-2257"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "AMY",
"middle_name": "ELIZABETH",
"name_prefix": "Miss",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-12-13",
"last_updated": "2023-12-13",
"certification_date": "2023-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "86498",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in College Station, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.