Healthcare Provider Details

I. General information

NPI: 1609868256
Provider Name (Legal Business Name): ALBERT TOBIAS NOELLE II LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TOBY NOELLE LCSW,LMHC

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 WEST ALTO ROAD
KOKOMO IN
46902-6459
US

IV. Provider business mailing address

PO BOX 6459
KOKOMO IN
46904-6459
US

V. Phone/Fax

Practice location:
  • Phone: 765-453-7422
  • Fax: 765-453-3773
Mailing address:
  • Phone: 765-453-7422
  • Fax: 765-453-3773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34001764A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: