Lexington Psychological Services, PLLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810003867 Issued in VA

Legal business name

LEXINGTON PSYCHOLOGICAL SERVICES, PLLC

Doing business as

Glenn R. Sullivan, Ph.D.

Practice address

30 Crossing LN Ste 101
Lexington, VA 24450

Phone

(540) 463-2080

Fax

(540) 464-7648

NPI assigned

Mar 19, 2018

Last updated

May 17, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Glenn R. Sullivan, PH.D.NPI 1871764779

Title

Clinical Psychologist

Phone

(540) 463-2080

Specialties & licenses 1

Addresses

Other names 1

• Glenn R. Sullivan, Ph.D. Doing business as

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Glenn R Sullivan, PH.D.

  • Clinical Psychologist
  • Lexington, VA
  • NPI 1871764779
  Medicare reassignment NPD Authorized official
• Jean Cook, LCSW

  • Clinical Social Worker
  • Lexington, VA
  • NPI 1366490203
  NPD (past)

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

{
    "created_epoch": "1521417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526515200000",
    "number": "1992209720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 COLSTON PL",
            "city": "LEXINGTON",
            "state": "VA",
            "postal_code": "244501812",
            "telephone_number": "540-463-2080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 CROSSING LN STE 101",
            "city": "LEXINGTON",
            "state": "VA",
            "postal_code": "24450",
            "telephone_number": "540-463-2080",
            "fax_number": "540-464-7648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEXINGTON PSYCHOLOGICAL SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-19",
        "last_updated": "2018-05-17",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "540-463-2080",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810003867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glenn R. Sullivan, Ph.D.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Lexington Retirement Community, Inc (Kendal at Lexington)
• Lexington Smiles, PLLC
• Lexington Virginia Emergency Physicians LLP
• Lincare Inc.
• Keith Edward Lisenbee, L.C.S.W.

• Clinical Psychologist in Lexington, VA
• Providers in Lexington, VA by specialty
• Clinical Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.