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
Phone: (228) 604-0099
Fax: (228) 604-2001
Website:
Health care specialties
Specialty | Code | License # | 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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1508836537 | NPPES |
Mississippi | Other | LPC | MENTAL HEALTH |
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