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NPI Code Detail

MEDICARE: LONELL NOLEN

MEDICARE: LONELL NOLEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2103K00000XBehavior Analyst
3106S00000XBehavior Technician

General Provider Information

NPI Number : 1013353226
Entity Type Code : Individual
Provider Name (Legal Business Name) : LONELL NOLEN
Provider Business Mailing Address
First Line : 1404 OAK HAVEN WAY
Second Line :
City : ANTIOCH
State : CA
Zip : 94531-8032
Country : US
Telephone Number : 925-864-9114
Fax Number :
Provider Business Practice Location Address
First Line : 1025 ATLANTIC AVE STE 101
Second Line :
City : ALAMEDA
State : CA
Zip : 94501-1188
Country : US
Telephone Number : 510-268-8120
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2013
Last Update Date : 07/06/2022

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Directions to “ LONELL NOLEN ” Practice Location

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