Lysha A Sullivan

NPI #1881418051 in Jerome, Idaho

Provider Information

NPI Number: 1881418051
Entity Type: Individual
Name: Lysha A Sullivan
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Enumeration Date: Nov 13, 2024
Last Updated: Nov 13, 2024

Practice Location

Address: 130 S LINCOLN AVE
City: Jerome
State: Idaho
ZIP Code: 83338-2631
Phone: (208) 595-4950

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor	101Y00000X
Behavior Analyst	103K00000X
Student in an Organized Health Care Education/Training Program	390200000X
Behavior Technician	106S00000X	Primary

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