Provider Demographics
NPI:1417086448
Name:GLASS, VICKY LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VICKY
Middle Name:LYNN
Last Name:GLASS
Suffix:
Gender:F
Credentials:LCSW
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Other - First Name:
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Mailing Address - Street 1:1000 LAKE SAINT LOUIS BLVD
Mailing Address - Street 2:SUITE 261
Mailing Address - City:LAKE SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1340
Mailing Address - Country:US
Mailing Address - Phone:636-561-0268
Mailing Address - Fax:636-625-1580
Practice Address - Street 1:1000 LAKE SAINT LOUIS BLVD
Practice Address - Street 2:SUITE 261
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1340
Practice Address - Country:US
Practice Address - Phone:636-561-0268
Practice Address - Fax:636-625-1580
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20010205541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical