MS. JESSIE ELAINE SULLIVAN (NPI# 1063674786) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063674786 |
| Entity Type | Individual |
| Full Name | MS. JESSIE ELAINE SULLIVAN |
| Credential | LCPC,LMFT |
| Practice Address |
660 S Woodruff Ave Idaho Falls ID 83401-5299 |
| Mailing Address |
3785 Colts Glen Ln Idaho Falls ID 83404-8353 |
| Practice Telephone | 2085231558 |
| Practice Fax Number | 2085294788 |
| Mailing Telephone | 2085242411 |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2011-06-16 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
LCPC-119 | ID | Behavioral Health & Social Service Providers |
| N | 106H00000X | Marriage & Family Therapist | LMFT-2963 | ID | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225396575 | Jessie Mae Sullivan | Dietitian, Registered | 5353 N Union Blvd Ste 201-d, Colorado Springs, CO 80918-2065 | 2012-04-24 |
| Street Address |
660 S WOODRUFF AVE |
| City | IDAHO FALLS |
| State | ID |
| Zip Code | 83401-5299 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376981134 | Michele Marie Elsbree | Social Worker | 660 S Woodruff Ave, Idaho Falls, ID 83401-5299 | 2013-06-13 |
| 1982999074 | Lisa La'ree Kishiyama | Counselor | 660 S Woodruff Ave, Idaho Falls, ID 83401-5299 | 2011-06-16 |
| 1003101577 | Sullivan Mental Health Services LLC | Clinic/Center | 660 S Woodruff Ave, Idaho Falls, ID 83401-5299 | 2011-06-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407454796 | Natalie M Theriault | Acupuncturist | 864 S Holmes, Idaho Falls, ID 83401 | 2020-10-09 |
| 1366099293 | Idaho Recovery Center, LLC. | Counselor | 771 South Woodruff Avenue, Idaho Falls, ID 83401 | 2019-08-26 |
| 1851859110 | Rebecca Chidester | Counselor | 771 Parkwood St., Idaho Falls, ID 83401 | 2019-03-06 |
| 1467924985 | Benchmark Home Health | Registered Nurse | 2098 Gladys Dr., Idaho Falls, ID 83401 | 2018-12-21 |
| 1134625338 | Idaho Falls Hand Therapy Limited Partnership | Clinic/Center | 564 S Woodruff Avenue, Idaho Falls, ID 83401 | 2018-04-05 |
| 1992227367 | Brenda Emery | Rehabilitation Practitioner | 540 3rd Street, Idaho Falls, ID 83401 | 2017-07-07 |
| 1689068454 | Addiction Treatment Centers of Idaho | Community/Behavioral Health | 211 S. Woodruff Avenue, Idaho Falls, ID 83401 | 2015-03-19 |
| 1386986412 | Jennifer Lee Henderson | Psychologist | 111 E. 16th Street, Innovative Health Care Concepts Inc., Idaho Falls, ID 83401 | 2013-03-27 |
| 1487994430 | Sterling Physician Group Pllc | Clinic/Center | 740 S. Woodruff Ave, Idaho Falls, ID 83401 | 2013-02-27 |
| 1952638025 | Allstar Counseling Inc. | Case Management | 550 2nd Street, Suite 269, Idaho Falls, ID 83401 | 2009-11-11 |
| Find all providers in zip 83401 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609410489 | Angelika H Gutenberger | Counselor | 211 S Woodruff Ave Ste A3, Idaho Falls, ID 83401-4865 | 2019-11-04 |
| 1851859110 | Rebecca Chidester | Counselor | 771 Parkwood St., Idaho Falls, ID 83401 | 2019-03-06 |
| 1124590302 | A Penney for Your Thoughts, LLC | Counselor | 1820 E 17th St Ste 190, Idaho Falls, ID 83404-6518 | 2018-12-27 |
| 1346790128 | Molli Gilchrist | Counselor | 760 K St Apt B, Idaho Falls, ID 83402-2770 | 2016-10-05 |
| 1508256850 | Itzel Montero | Counselor | 3442 S. 15th E., Idaho Falls, ID 83404 | 2015-01-26 |
| 1457610149 | Kimberly W. Johnson | Counselor | 1934 N 26th W, Idaho Falls, ID 83402-5319 | 2012-05-15 |
| 1477823490 | Annette Marie Cowley | Counselor | 1273 E 17th St, Idaho Falls, ID 83404-6126 | 2012-01-06 |
| 1619102183 | Quinn Blake Thibodeau | Counselor | 1891 Grandview Ct, Idaho Falls, ID 83402-2510 | 2009-05-27 |
| 1679711998 | New Journeys Inc | Counselor | 1047 Oxbow Ln, Idaho Falls, ID 83404-8351 | 2009-01-23 |
| 1093964041 | Nathan James Fullmer | Counselor | 4707 1st St, Idaho Falls, ID 83401-5771 | 2008-09-15 |
| Find all providers in IDAHO FALLS | ||||
| City | IDAHO FALLS |
| Zip Code | 83401 |
Please comment or provide details below to improve the information on MS. JESSIE ELAINE SULLIVAN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.