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Mr. Bruce Wayne Sullivan, LPC
Professional Counselor in Gulfport, Mississippi
NPI 1508836537

Bruce Wayne Sullivan is a Professional Counselor based in Gulfport, MS and is specialized in Professional. Bruce Wayne Sullivan practices in Gulfport, MS and has the professional credentials of LPC. The NPI Number for Bruce Wayne Sullivan is 1508836537 and holds a License No. 0727 (Mississippi).

The current practice location address for Bruce Wayne Sullivan is 450 E Pass Rd, Gulfport, MS and can be reached out via phone at 228-604-0099 and via fax at 228-604-2001. You can also correspond with Bruce Wayne Sullivan through the mailing address at 450 E PASS RD, GULFPORT, MS - 39507-3212 (mailing address contact number: 228-604-0099).

Location: 450 E Pass Rd, Gulfport, MS, 39507-3212
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Provider Profile Details
NPI Number
1508836537
Provider Name
Bruce Wayne Sullivan
Credential
LPC
Provider Entity Type
Individual
Gender
Male
Address
450 E Pass Rd, Gulfport, MS, 39507-3212
Phone Number
228-604-0099
Fax Number
228-604-2001
Provider Enumeration Date
01/24/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
LPC 01 MS MENTAL HEALTH
institution
Provider Business Practice Location Address Details
Address
450 E Pass Rd
City
State
Zip
39507-3212
Phone Number
228-604-0099
Fax Number
228-604-2001
person
Provider Business Mailing Address Details
Address
450 E Pass Rd
City
State
Zip
39507-3212
Phone Number
228-604-0099
Fax Number
228-604-2001
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Professional
Taxonomy
License No.
0727 (Mississippi)
Definition
Definition to come...
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