Provider Demographics
NPI:1851586838
Name:REICHERT-GULLY, LINDSEY M (MA, PSYD)
Entity Type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:M
Last Name:REICHERT-GULLY
Suffix:
Gender:F
Credentials:MA, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 505164
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5164
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:2030 S NATIONAL AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2222
Practice Address - Country:US
Practice Address - Phone:417-820-9590
Practice Address - Fax:417-820-9592
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008033045103TC0700X
MO2007025941101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1851586838Medicaid
MO991507006Medicare PIN
MO991333002Medicare PIN