Healthcare Provider Details

I. General information

NPI: 1467508473
Provider Name (Legal Business Name): NOEL JOY PLOURDE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 06/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 CULVER BLVD SUITE P
PLAYA DEL REY CA
90293-7788
US

IV. Provider business mailing address

211 CULVER BLVD SUITE P
PLAYA DEL REY CA
90293-7788
US

V. Phone/Fax

Practice location:
  • Phone: 310-577-2225
  • Fax:
Mailing address:
  • Phone: 310-577-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC21757
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: