Glinda Mae Sullivan, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2004024741 Issued in MO

Practice address

106 4 Seasons Ctr
Suite 106C
Chesterfield, MO 63017-3173

Phone

(573) 528-7569

Fax

(314) 439-5036

NPI assigned

Apr 27, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Glinda Sullivan, PSYD

  • Clinical Psychologist
  • Waynesville, MO
  • NPI 1679766307
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343001600000",
    "number": "1679793897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 4 SEASONS CTR",
            "address_2": "SUITE 106C",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630173173",
            "telephone_number": "573-528-7569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 4 SEASONS CTR",
            "address_2": "SUITE 106C",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630173173",
            "telephone_number": "573-528-7569",
            "fax_number": "314-439-5036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "GLINDA",
        "middle_name": "MAE",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-27",
        "last_updated": "2012-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "2004024741",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.007644",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "499462307",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Miguel Milton Suazo Martinez, MD
• Success Vision Express of Chesterfield LLC
• Success Vision Eyecare of Chesterfield LLC
• Rishi Nath Sud, M.D.
• Kari Elizabeth Sufficool, M.D.
• Katherine Jo Sullivan, CTRS
• Timothy Byrne Sullivan, DC
• Jennifer Summers, PA-C, RD
• Summit Specialty Transport
• Andrew Sun, MD

• Clinical Psychologist in Chesterfield, MO
• Providers in Chesterfield, MO by specialty
• Clinical Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.