Provider Demographics
NPI:1588063929
Name:NOBO, MICHAEL PAUL FRANKLIN (LMSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PAUL FRANKLIN
Last Name:NOBO
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64124-2323
Mailing Address - Country:US
Mailing Address - Phone:816-474-4920
Mailing Address - Fax:816-889-1847
Practice Address - Street 1:2121 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2126
Practice Address - Country:US
Practice Address - Phone:816-471-0900
Practice Address - Fax:816-471-3150
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20160030451041C0700X
KS9318104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2016003045OtherLICENSE
MO1588063929Medicaid