Provider Demographics
NPI:1821405077
Name:PINNELL, NICHOLAS (MA)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:PINNELL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10600 W 115TH TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-3020
Mailing Address - Country:US
Mailing Address - Phone:913-832-3109
Mailing Address - Fax:
Practice Address - Street 1:6801 E 117TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64134-3701
Practice Address - Country:US
Practice Address - Phone:816-554-5506
Practice Address - Fax:816-554-5550
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014012390101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional