Healthcare Provider Details

I. General information

NPI: 1255995437
Provider Name (Legal Business Name): BRADFORD NOBLE MS, LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7741 LOOKOUT DR
LA JOLLA CA
92037-3949
US

IV. Provider business mailing address

7741 LOOKOUT DR
LA JOLLA CA
92037-3949
US

V. Phone/Fax

Practice location:
  • Phone: 212-543-0111
  • Fax:
Mailing address:
  • Phone: 212-543-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number21314
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: