Provider Demographics
NPI:1639685217
Name:COLLIER, GLYNIS JUDEEN
Entity type:Individual
Prefix:
First Name:GLYNIS
Middle Name:JUDEEN
Last Name:COLLIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:
Other - Last Name:BARNETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:GLYNIS COLLIER, LPC
Mailing Address - Street 1:PO BOX 1063
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-1063
Mailing Address - Country:US
Mailing Address - Phone:803-466-7031
Mailing Address - Fax:
Practice Address - Street 1:105 S EUCLID AVE STE A
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-3173
Practice Address - Country:US
Practice Address - Phone:803-466-7031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD20200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty