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General NPI Number Information
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NPI Number | 1154623593
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Entity Type | Organization
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Legal Business Name | NOBLES PSYD LP LLC
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Dates
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Enumeration Date | 11/17/2010
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Last Update Date | 06/08/2020
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Provider Practice Location Address
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Address Line | 241 CLEVELAND AVE S SUITE 2D
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City | SAINT PAUL
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State | MN
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Zip | 55105-1208
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Country | US
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Telephone | 651-698-2326
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Fax | 651-690-0906
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Provider Business Mailing Address
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Address Line | 241 CLEVELAND AVE S SUITE 2D
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City | SAINT PAUL
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State | MN
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Zip | 55105-1208
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Country | US
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Telephone | 651-698-2326
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Fax | 651-690-0906
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | YVONNE FERNANDEZ NOBLES
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Credential | PSYD
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Telephone | 651-698-2326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | LP4435
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License Number State | MN
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