Healthcare Provider Details

I. General information

NPI: 1174291272
Provider Name (Legal Business Name): KEVIN GEORGE NOBLE LAC, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 W 69TH ST UNIT 103
SIOUX FALLS SD
57108-5622
US

IV. Provider business mailing address

2927 E MARSON DR APT E
SIOUX FALLS SD
57103-4730
US

V. Phone/Fax

Practice location:
  • Phone: 605-740-6557
  • Fax:
Mailing address:
  • Phone: 605-677-9402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number21011864
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT11564
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier21011864
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerLAC LICENSE
# 2
IdentifierLMFT11564
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerSD DEPARTMENT OF SOCIAL SERVICES BOARD OF EXAMINERS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: