Provider Demographics
NPI:1033434584
Name:MINOR, MEDELYN YOLANDA SULLIVAN (LPC)
Entity type:Individual
Prefix:
First Name:MEDELYN
Middle Name:YOLANDA SULLIVAN
Last Name:MINOR
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 190226
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-6226
Mailing Address - Country:US
Mailing Address - Phone:314-650-3905
Mailing Address - Fax:314-890-2034
Practice Address - Street 1:1550 WALL ST
Practice Address - Street 2:STE. 244
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-3545
Practice Address - Country:US
Practice Address - Phone:314-650-3905
Practice Address - Fax:314-890-2034
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-27
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2005009307101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional