Theodore Sullivan | Valparaiso, IN • PECOS Search

Theodore Sullivan

Counselor

Behavioral Health & Social Service Providers

2501 Valley Dr, Valparaiso, IN 46383-2518

PECOS Enrollment

Based on the most recent information from CMS, provider Theodore Sullivan does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1730947599
Provider Type
Individual
Full Name
Sullivan, Theodore
Credential
LMHCA

Gender
Male
Sole Proprietor
No
Enumeration Date
3/7/2024
Last Updated
3/7/2024

Contact Information

Practice Location

2501 Valley Dr, Valparaiso, IN 46383-2518

Unlisted Fax

Mailing Location

1487 N Brummitt Rd, Chesterton, IN 46304-8710

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 101YM0800X Primary	Description Counselor Behavioral Health & Social Service Providers	License 88002140A Indiana