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Mariah Wynne Beck Sullivan

NPI Registration Record

Provider / OrganizationNPIDate Certified
MARIAH WYNNE BECK SULLIVAN11741153982021-07-12

Mariah Wynne Beck Sullivan is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1174115398. Registration indicates Mariah Wynne Beck Sullivan is a provider of access to mental health/behavioral health providers services with a specialization in Behavioral Health & Social Service Providers, Counselor (Behavioral Health & Social Service Providers, Counselor) (Counselor: Mental Health, ) (Behavioral Health/Substance Abuse/Psychiatry, ) (Counselor Mental Health, Behavioral Health & Social Service Providers) (Counselor, )

Entity TypeIndividual
Provider Name Mariah Wynne Beck Sullivan
Practice Office Address3825 INTERNATIONAL CT
SPRINGFIELD, OR US
Practice Office Telephone5418588170
Practice Office Fax5418588167
Mailing Address3587 HEATHROW WAY
MEDFORD, OR 975044004 US
Business Telephone5418588170
Business Fax5418588167
HPT Codes
CodePractice
License No
State
101YM0800X PRIMARYAccess to Mental Health/Behavioral Health Providers
Behavioral Health & Social Service Providers
Counselor
Behavioral Health & Social Service Providers
Counselor
Counselor: Mental Health

Behavioral Health/Substance Abuse/Psychiatry

Counselor Mental Health
Behavioral Health & Social Service Providers
Counselor
OPI Codes

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