Provider Demographics
NPI:1285127233
Name:GLASS, SUSAN LYNN (PSYD, LMLP)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LYNN
Last Name:GLASS
Suffix:
Gender:F
Credentials:PSYD, LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SOUTHWIND PL STE 106
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-3186
Mailing Address - Country:US
Mailing Address - Phone:785-256-0402
Mailing Address - Fax:
Practice Address - Street 1:200 SOUTHWIND PL STE 106
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-3186
Practice Address - Country:US
Practice Address - Phone:559-907-4589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2816103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist