Provider Demographics
NPI:1518135086
Name:SULLENTRUP, GLENDA SUE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:SUE
Last Name:SULLENTRUP
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S BEMISTON AVE
Mailing Address - Street 2:SUITE 1450
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1907
Mailing Address - Country:US
Mailing Address - Phone:314-727-4422
Mailing Address - Fax:
Practice Address - Street 1:230 S BEMISTON AVE
Practice Address - Street 2:SUITE 1450
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-1907
Practice Address - Country:US
Practice Address - Phone:314-727-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002344101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional