Healthcare Provider Details

I. General information

NPI: 1326658345
Provider Name (Legal Business Name): JUSTIN NOONAN M.ED., BCBA, LBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 S CEDAR ST STE A
TACOMA WA
98409-5728
US

IV. Provider business mailing address

3023 S 14TH ST
TACOMA WA
98405-2410
US

V. Phone/Fax

Practice location:
  • Phone: 206-313-8840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: