Healthcare Provider Details

I. General information

NPI: 1215614904
Provider Name (Legal Business Name): CREE NOBLE M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 07/09/2023
Certification Date: 07/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4028 W IRVING PARK RD
CHICAGO IL
60641-2925
US

IV. Provider business mailing address

812 ROSELYN DR
RANTOUL IL
61866-1661
US

V. Phone/Fax

Practice location:
  • Phone: 773-850-9046
  • Fax:
Mailing address:
  • Phone: 217-390-7607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: