Individual ProviderCrystal SullivanSocial WorkerBehavioral Health & Social Service ProvidersPractice Address106 Heymann Blvd, Lafayette, LA 70503-2322(337) 504-4279PECOS EnrollmentBased on the most recent information from CMS, provider Crystal 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 ID1902632953Provider TypeIndividualFull NameSullivan, CrystalCredentialLCSWGenderFemaleSole ProprietorNoEnumeration Date9/9/2024Last Updated9/9/2024Contact InformationPractice LocationPractice Address106 Heymann Blvd, Lafayette, LA 70503-2322Phone(337) 504-4279FaxUnlisted FaxMailing LocationMailing Address106 Heymann Blvd, Lafayette, LA 70503-2322PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense4453Louisiana