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General NPI Number Information
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NPI Number | 1033434584
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Entity Type | Individual
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Provider Name | MEDELYN YOLANDA SULLIVAN MINOR LPC
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Gender | Female
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Dates
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Enumeration Date | 03/27/2010
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 1550 WALL ST STE. 244
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City | SAINT CHARLES
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State | MO
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Zip | 63303-3545
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Country | US
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Telephone | 314-650-3905
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Fax | 314-890-2034
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Provider Business Mailing Address
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Address Line | PO BOX 190226
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City | SAINT LOUIS
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State | MO
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Zip | 63119-6226
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Country | US
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Telephone | 314-650-3905
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Fax | 314-890-2034
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2005009307
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License Number State | MO
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