Healthcare Provider Details

I. General information

NPI: 1497297097
Provider Name (Legal Business Name): CALEB JOSPEH-CHARLES NOBLE MA, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 36TH ST SE
GRAND RAPIDS MI
49512-2810
US

IV. Provider business mailing address

360 E BELTLINE AVE NE STE 100
GRAND RAPIDS MI
49506-1214
US

V. Phone/Fax

Practice location:
  • Phone: 616-942-2110
  • Fax:
Mailing address:
  • Phone: 616-805-3660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401017650
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: