Sullivan, Bruce Wayne

Sullivan, Bruce Wayne is an sole proprietor health care provider with primary practice located at 450 E Pass Rd Ste. 3, Gulfport MS 39507-3212. He recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as his primary health care specialty. Sullivan, Bruce Wayne can be contacted via phone (228) 604-0099.

Contact Information

Primary practice address
450 E Pass Rd Ste. 3 Gulfport MS 39507-3212
Fax: (228) 604-2001
Website:

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 0727 Mississippi

Profile Details

NPI number 1508836537
LBN Legal business name Sullivan, Bruce Wayne
Credentials Licensed Professional Counselor (LPC)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 24th, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508836537 NPPES
Mississippi Other LPC MENTAL HEALTH

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