Healthcare Provider Details

I. General information

NPI: 1649187253
Provider Name (Legal Business Name): TANNER ROBERT NOBLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1646 INDUSTRY RD
ATWATER OH
44201
US

IV. Provider business mailing address

2171 LEXINGTON AVE NW
WARREN OH
44485-1407
US

V. Phone/Fax

Practice location:
  • Phone: 330-947-2664
  • Fax:
Mailing address:
  • Phone: 300-947-2664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: