Provider Demographics
NPI:1689714958
Name:O'SULLIVAN, STEPHEN PATRICK (MS, QMHP)
Entity type:Individual
Prefix:MISS
First Name:STEPHEN
Middle Name:PATRICK
Last Name:O'SULLIVAN
Suffix:
Gender:M
Credentials:MS, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9268 SE CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-1456
Mailing Address - Country:US
Mailing Address - Phone:503-872-0483
Mailing Address - Fax:
Practice Address - Street 1:9268 SE CLINTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-1456
Practice Address - Country:US
Practice Address - Phone:503-872-0483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health