| Doctor Name: | MEDELYN YOLANDA SULLIVAN MINOR |
| NPI Number: | 1033434584 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | 2005009307 |
| Business Practice Address: | 1550 Wall St Ste. 244 Saint Charles, MO - 633033545 |
| Business Phone Number: | 3146503905 |
| Business Fax Number: | 3148902034 |
| Mailing Address: | Po Box 190226, SAINT LOUIS |
| State: | MO |
| Postal Code: | 631196226 |
| Phone Number: | 3146503905 |
| Fax Number: | 3148902034 |
| NPI Enumeration Date: | 03/27/2010 |
| NPI Last Update Date: | 10/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 2005009307 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |