Healthcare Provider Details

I. General information

NPI: 1487218251
Provider Name (Legal Business Name): NOBLES COUNSELING GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2019
Last Update Date: 04/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 BROADMOOR DR STE 301
BRYAN TX
77802-5220
US

IV. Provider business mailing address

1713 BROADMOOR DR STE 301
BRYAN TX
77802-5220
US

V. Phone/Fax

Practice location:
  • Phone: 936-463-8120
  • Fax: 979-383-2199
Mailing address:
  • Phone: 936-463-8120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. JUSTIN SCOTT NOBLES
Title or Position: PRESIDENT
Credential: LPC, LCDC
Phone: 936-463-8120