Kenneth P. Sullivan, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

413 Issued in AL

Practice address

1104 Gleneagles Dr SW # B
Huntsville, AL 35801-6404

Phone

(256) 880-8202

Fax

(256) 880-8234

NPI assigned

Jan 5, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Cobblestone Psych Ctr

  • Psychiatry Physician
  • Huntsville, AL
  • NPI 1649452269
  NPD (past)

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1932256302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1104 GLENEAGLES DR SW # B",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358016404",
            "telephone_number": "256-880-8202",
            "fax_number": "256-880-8234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 GLENEAGLES DR SW # B",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358016404",
            "telephone_number": "256-880-8202",
            "fax_number": "256-880-8234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KENNETH",
        "middle_name": "P.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-05",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "AL",
            "license": "413",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000070874",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristin S Sullins, OD
• William H Sullins, OD
• Breanna Kristen Sullivan
• Brenna Kathleen Sullivan, RN, SRNA
• Josephine Sullivan, LPN
• Kyla Sullivan
• Mary Barbara Sullivan, M.D.
• Melanie Prince Sullivan, CRNP
• Peter J Sullivan, PA-C
• Arzoria Cenai Sumbry, RBT

• Clinical Psychologist in Huntsville, AL
• Providers in Huntsville, AL by specialty
• Clinical Psychologist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.