Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Michael Kevin Sullivan

Individual provider Mental Health Counselor · NPI 1336808179

Michael Kevin Sullivan is a Mental Health Counselor in Jacksonville, Florida. Qualified in 2021, 5 years ago. Practices with Mindy Staum LCSW PA, a 16-clinician group and accepts Medicare assignment.

Years since qualifying
5
In the registry since
2021
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Practice location Address checks out

3027 San Diego Rd
Jacksonville, FL 32207-3691
Phone: (904) 493-7744
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X

Record details

NPI number1336808179
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedDecember 9, 2021
Last updated in NPPESDecember 9, 2021
Certification dateDecember 9, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Mindy Staum Lcsw Pa — 16 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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