| Lexington Psychological Services, Pllc | |
|
30 Crossing Ln Ste 101 Lexington VA 24450 | |
| (540) 463-2080 | |
| (540) 464-7648 |
| Full Name | Lexington Psychological Services, Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 30 Crossing Ln Ste 101, Lexington, Virginia |
| Authorized Official Name and Position | Glenn R. Sullivan (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 5404632080 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lexington Psychological Services, Pllc 106 Colston Pl Lexington VA 24450-1812 Ph: (540) 463-2080 | Lexington Psychological Services, Pllc 30 Crossing Ln Ste 101 Lexington VA 24450 Ph: (540) 463-2080 |
| NPI Number | 1992209720 |
|---|---|
| Provider Enumeration Date | 03/19/2018 |
| Last Update Date | 05/17/2018 |
| Medicare PECOS PAC ID | 4880958032 |
|---|---|
| Medicare Enrollment ID | O20180516000700 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992209720 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 0810003867 (Virginia) | Primary |
| Provider Name | Glenn R Sullivan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1871764779 PECOS PAC ID: 0648331025 Enrollment ID: I20081203000678 |
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