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General NPI Number Information
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NPI Number | 1265376131
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Entity Type | Individual
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Provider Name | STEPHAN ROBERT NOLL
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Gender | Male
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Dates
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Enumeration Date | 04/20/2026
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Last Update Date | 04/20/2026
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Provider Practice Location Address
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Address Line | 1411 32ND ST S STE 1
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City | FARGO
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State | ND
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Zip | 58103-6304
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Country | US
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Telephone | 701-264-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 808 3RD AVE S STE 303
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City | FARGO
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State | ND
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Zip | 58103-1865
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Country | US
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Telephone | 701-248-8330
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1537-4-15-26A
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License Number State | ND
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