Tyesha T Sullivan, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

123866 Issued in CA

Practice address

540 N California St
Stockton, CA 95202-2117

Phone

(209) 464-4524

NPI assigned

Feb 2, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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

• Grow Healthcare Group PC

  • Mental Health Counselor
  • San Jose, CA
  • NPI 1154994846

  Marriage & Family Therapist

  Medicare reassignment NPD
• San Joaquin County Child Abuse Prevention Council

  • Community/Behavioral Health Agency
  • Stockton, CA
  • NPI 1316221765
  NPD (past)

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

{
    "created_epoch": "1643760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691452800000",
    "number": "1871246462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4447 ABRUZZI CIR",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952066097",
            "telephone_number": "209-818-4711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 N CALIFORNIA ST",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952022117",
            "telephone_number": "209-464-4524"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4447 Abruzzi Cir",
            "address_purpose": "LOCATION",
            "city": "Stockton",
            "state": "CA",
            "postal_code": "952066097",
            "country_code": "US",
            "telephone_number": "209-818-4711",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "TYESHA",
        "middle_name": "T",
        "name_prefix": "Mrs.",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-02",
        "last_updated": "2023-08-08",
        "certification_date": "2023-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "123866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bonnie Sugawara, PHARMD
• Erin Tomiko Sugiyama, PHARM.D.
• Angeline Suico
• Suliman Orthodontics Inc.
• June Untalan Sulivan, MFTI
• Ahmad Sultan
• Criselle Jane Carillo Sumampong
• Sakina Kanani Sumandal
• Jennie Sumano
• Rachel Abella Sumaquial, RACHEL SUMAQUIAL, PA

• Marriage & Family Therapist in Stockton, CA
• Providers in Stockton, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.