Individual ProviderJack F SullivanMarriage & Family TherapistBehavioral Health & Social Service ProvidersPractice Address8058 La Mesa Blvd., La Mesa, CA 91942-0335(619) 507-8270PECOS EnrollmentBased on the most recent information from CMS, provider Jack F Sullivan does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1528261013Provider TypeIndividualFull NameSullivan, Jack FCredentialMA, MFTGenderMaleSole ProprietorYesEnumeration Date6/11/2007Last Updated11/19/2011Contact InformationPractice LocationPractice Address8058 La Mesa Blvd., La Mesa, CA 91942-0335Phone(619) 507-8270Fax(619) 463-2522Mailing LocationMailing Address8058 La Mesa Blvd., La Mesa, CA 91942Phone(619) 507-8270Fax(619) 463-2522Provider TaxonomiesCodeDescriptionLicenseCode106H00000XPrimaryDescriptionMarriage & Family TherapistBehavioral Health & Social Service ProvidersLicenseMFC 49227California