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General NPI Number Information
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NPI Number | 1174573067
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Entity Type | Organization
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Legal Business Name | NORTHTOWN PSYCHOLOGY ASSOCIATES LLC
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 02/02/2021
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Provider Practice Location Address
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Address Line | 199 COON RAPIDS BLVD NW STE 113
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City | COON RAPIDS
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State | MN
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Zip | 55433-5859
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Country | US
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Telephone | 763-785-8111
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Fax | 763-785-6946
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Provider Business Mailing Address
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Address Line | 199 COON RAPIDS BLVD NW STE 113
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City | COON RAPIDS
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State | MN
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Zip | 55433-5859
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Country | US
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Telephone | 763-785-8111
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Fax | 763-785-6946
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Authorized Official
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Title or Position | PSYCHOLOGIST/CO-OWNER
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Name | DR. GAIL A NOLLER
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Credential | PSYD, LP
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Telephone | 763-785-8111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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