SEAN ALYSTON SULLIVAN CASE MANAGER NPI 1194366070

NPI Information

NPI: 1194366070
Provider Name: SEAN ALYSTON SULLIVAN, CASE MANAGER
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
2600 CORDOVA ST
ANCHORAGE, AK
ZIP 99503
Phone: (907) 279-9640
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Sean Alyston Sullivan, CASE MANAGER is an addiction (substance use disorder) counselor in Anchorage, AK. Sean Alyston Sullivan, CASE MANAGER NPI is 1194366070. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2600 CORDOVA ST
ANCHORAGE, AK
ZIP 99503-745
Phone: (907) 279-9640

The enumeration date for this NPI number is 10/2/2019 and was last updated on 3/31/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	1194366070	ALASKA	No
2	171M00000X	Case Manager/Care Coordinator			ALASKA	No
3	101YA0400X	Counselor	Addiction (Substance Use Disorder)			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1194366070	MEDICAID	ALASKA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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