| Doctor Name: | MRS. VICKY LYNN GLASS |
| NPI Number: | 1417086448 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.C.S.W. |
| License Number: | 2001020554 |
| Business Practice Address: | 1000 Lake Saint Louis Blvd Suite 261 Lake Saint Louis, MO - 633671340 |
| Business Phone Number: | 6365610268 |
| Business Fax Number: | 6366251580 |
| Mailing Address: | 1000 Lake Saint Louis Blvd, Suite 261 LAKE SAINT LOUIS |
| State: | MO |
| Postal Code: | 633671340 |
| Phone Number: | 6365610268 |
| Fax Number: | 6366251580 |
| NPI Enumeration Date: | 03/05/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 2001020554 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |