Healthcare Provider Details

I. General information

NPI: 1235531740
Provider Name (Legal Business Name): DR. THOMAS C. NOYES, PHD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 JOLEE DR
HEBRON KY
41048-9515
US

IV. Provider business mailing address

1503 JOLEE DR
HEBRON KY
41048-9515
US

V. Phone/Fax

Practice location:
  • Phone: 859-816-3862
  • Fax:
Mailing address:
  • Phone: 859-816-3862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1564
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0291
License Number StateKY

VIII. Authorized Official

Name: THOMAS NOYES
Title or Position: OWNER/PROVIDER
Credential:
Phone: 859-816-3862