Provider Demographics
NPI:1962001628
Name:GLATZ-NEKULA, SANDRA CAROL (PLPC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:CAROL
Last Name:GLATZ-NEKULA
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:CAROL
Other - Last Name:GLATZ-NEKULA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PLPC
Mailing Address - Street 1:1137 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-1498
Mailing Address - Country:US
Mailing Address - Phone:636-294-2694
Mailing Address - Fax:
Practice Address - Street 1:1137 N MAIN ST
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-1498
Practice Address - Country:US
Practice Address - Phone:636-294-2694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020031379101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional