Healthcare Provider Details

I. General information

NPI: 1639685217
Provider Name (Legal Business Name): GLYNIS JUDEEN COLLIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NONE BARNETT GLYNIS COLLIER, LPC

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S EUCLID AVE STE A
PIERRE SD
57501-3173
US

IV. Provider business mailing address

PO BOX 1063
PIERRE SD
57501-1063
US

V. Phone/Fax

Practice location:
  • Phone: 803-466-7031
  • Fax:
Mailing address:
  • Phone: 803-466-7031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20200
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: