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General NPI Number Information
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NPI Number | 1649993346
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Entity Type | Organization
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Legal Business Name | THE NOELL COLLABORATIVE, LLC
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Dates
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Enumeration Date | 09/19/2022
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Last Update Date | 09/19/2022
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Provider Practice Location Address
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Address Line | 2451 EXECUTIVE DR STE 205-2
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City | SAINT CHARLES
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State | MO
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Zip | 63303-5606
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Country | US
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Telephone | 314-266-8296
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Fax |
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Provider Business Mailing Address
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Address Line | 20 WHISTLING WIND CT
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City | WENTZVILLE
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State | MO
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Zip | 63385-5552
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Country | US
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Telephone | 314-477-7326
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MIKAH SALONIES
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Credential |
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Telephone | 314-266-8296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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