Healthcare Provider Details

I. General information

NPI: 1417502451
Provider Name (Legal Business Name): JESSICA R NOE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1047 S HIGHWAY 25 W
WILLIAMSBURG KY
40769-1639
US

IV. Provider business mailing address

PO BOX 540
JELLICO TN
37762-0540
US

V. Phone/Fax

Practice location:
  • Phone: 606-549-2656
  • Fax:
Mailing address:
  • Phone: 423-784-8492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number295339
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: