Individual ProviderMichael A Sullivan-TibbsSocial WorkerBehavioral Health & Social Service ProvidersPractice Address1030 Jefferson Ave, Memphis, TN 38104-2127(317) 748-8710(615) 225-4729PECOS EnrollmentBased on the most recent information from CMS, provider Michael A Sullivan-Tibbs 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 2 days ago.Profile DetailsProvider ID1720394562Provider TypeIndividualFull NameSullivan-Tibbs, Michael ATitleDr.CredentialLCSW, LCACGenderMaleSole ProprietorYesEnumeration Date8/30/2010Last Updated2/14/2019Contact InformationPractice LocationPractice Address1030 Jefferson Ave, Memphis, TN 38104-2127Phone(317) 748-8710FaxUnlisted FaxMailing LocationMailing Address3400 Lebanon Rd, Murfreesboro, TN 37129-1392Phone(615) 225-4729FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense34005914AIndianaCode101YA0400XDescriptionCounselorBehavioral Health & Social Service ProvidersLicense87000061AIndiana