Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
TANITA SHANTA SULLIVAN
Active Sole ProprietorTANITA SHANTA SULLIVAN is a Intellectual Disabilities Residential Treatment Facility healthcare provider located in WILLIS, Texas. NPI 1659671147 is currently active in the NPPES registry. Verify at CMS.
Intellectual Disabilities Residential Treatment Facility · WILLIS, TX
Registration Details
- NPI Number
- 1659671147
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Oct 29, 2010 (15.611056714365 yrs)
- Last Updated
- Oct 29, 2010
- Sole Proprietor
- Yes
Practice Information
- Address
-
13985 BROKEN ARROW DRWILLIS, TX, 773784323Browse TX providers · Browse ZIP 77378
- Phone
- 9368566136
- Fax
- 9368567549
- Primary Specialty
-
Intellectual Disabilities Residential Treatment Facility
320600000X
- Additional Specialty
- Physical Disabilities Residential Treatment Facility
- Additional Specialty
- Emotionally Disturbed Children Residential Treatment
- Additional Specialty
- Substance Abuse Rehabilitation Facility
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.