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General NPI Number Information
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NPI Number | 1083612865
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Entity Type | Organization
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Legal Business Name | NOLL PSYCHOLOGICAL GROUP, INC
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Dates
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Enumeration Date | 07/14/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 15515 N MOUNT OLIVET RD
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City | SMITHVILLE
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State | MO
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Zip | 64089-9076
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Country | US
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Telephone | 816-835-9882
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Fax |
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Provider Business Mailing Address
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Address Line | 15515 N MOUNT OLIVET RD
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City | SMITHVILLE
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State | MO
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Zip | 64089-9076
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Country | US
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Telephone | 816-835-9882
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Fax |
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Authorized Official
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Title or Position | CORPORATE SECRETARY
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Name | DR. NICHOLAS NOLL
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Credential | PH.D.
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Telephone | 816-835-9882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PYR0288
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PYR0288
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY01864
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License Number State | MO
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