Provider Demographics
NPI:1336376508
Name:FLAVELL, NONNIE J (ACSW/LCSW)
Entity Type:Individual
Prefix:
First Name:NONNIE
Middle Name:J
Last Name:FLAVELL
Suffix:
Gender:F
Credentials:ACSW/LCSW
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:KANE-PYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACSW/LCSW
Mailing Address - Street 1:1600 S. HWY UU
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205
Mailing Address - Country:US
Mailing Address - Phone:573-445-0867
Mailing Address - Fax:
Practice Address - Street 1:117 N GARTH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203
Practice Address - Country:US
Practice Address - Phone:573-449-2581
Practice Address - Fax:573-449-2583
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001299101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor