MR. Bruce Wayne Sullivan, LPC
NPI #1508836537 in Gulfport, Mississippi
Provider Information
- NPI Number
- 1508836537
- Entity Type
- Individual
- Name
- MR. Bruce Wayne Sullivan, LPC
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Counselor - Professional
- Credential
- LPC
- Enumeration Date
- Jan 24, 2006
- Last Updated
- Jul 8, 2007
Practice Location
- Address
- 450 E PASS RD
- Address 2
- STE. 3
- City
- Gulfport
- State
- Mississippi
- ZIP Code
- 39507-3212
- Phone
- (228) 604-0099
Specialties & Taxonomy Codes
| Specialty |
|---|
| Counselor - Professional — Professional |
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