Provider Demographics
NPI:1174573067
Name:NORTHTOWN PSYCHOLOGY ASSOCIATES LLC
Entity type:Organization
Organization Name:NORTHTOWN PSYCHOLOGY ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:NOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LP
Authorized Official - Phone:763-785-8111
Mailing Address - Street 1:199 COON RAPIDS BLVD NW STE 113
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-5859
Mailing Address - Country:US
Mailing Address - Phone:763-785-8111
Mailing Address - Fax:763-785-6946
Practice Address - Street 1:199 COON RAPIDS BLVD NW STE 113
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5859
Practice Address - Country:US
Practice Address - Phone:763-785-8111
Practice Address - Fax:763-785-6946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty