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General NPI Number Information
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NPI Number | 1154826469
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Entity Type | Organization
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Legal Business Name | NOLAN'S PLACE LLC
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Dates
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Enumeration Date | 03/28/2018
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Last Update Date | 08/25/2021
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Provider Practice Location Address
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Address Line | 515 19TH AVE SW
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City | WILLMAR
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State | MN
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Zip | 56201-5274
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Country | US
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Telephone | 320-403-5247
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Fax | 320-403-5249
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Provider Business Mailing Address
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Address Line | 515 19TH AVE SW
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City | WILLMAR
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State | MN
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Zip | 56201-5274
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Country | US
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Telephone | 320-403-5247
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Fax | 320-403-5249
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SALLIE GRAVES
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Credential |
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Telephone | 507-401-1467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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