Healthcare Provider Details

I. General information

NPI: 1750036562
Provider Name (Legal Business Name): NOEL VICKERY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 N TWYMAN RD
INDEPENDENCE MO
64058-3211
US

IV. Provider business mailing address

3205 N TWYMAN RD
INDEPENDENCE MO
64058-3211
US

V. Phone/Fax

Practice location:
  • Phone: 816-750-1813
  • Fax:
Mailing address:
  • Phone: 816-750-1813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2025048692
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: