Basic Information
| Provider Information | |||||||||
| NPI: | 1891201869 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOAKES | ||||||||
| FirstName: | NATHAN | ||||||||
| MiddleName: | EUGENE | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5301 FARAON ST STE 120 | ||||||||
| Address2: | |||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MO | ||||||||
| PostalCode: | 645063512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162711066 | ||||||||
| FaxNumber: | 8162716786 | ||||||||
| Practice Location | |||||||||
| Address1: | 114 E SOUTH HILLS DR | ||||||||
| Address2: | |||||||||
| City: | MARYVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 644682659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6605622525 | ||||||||
| FaxNumber: | 6605624301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2017 | ||||||||
| LastUpdateDate: | 11/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 2018004466 | MO | N | Behavioral Health & Social Service Providers | Social Worker | 104100000X | 10657 | KS | N | Behavioral Health & Social Service Providers | Social Worker | 104100000X | 2021009785 | MO | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.