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General NPI Number Information
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NPI Number | 1285160770
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Entity Type | Individual
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Provider Name | JAIME MELISSA NOLLE MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 05/03/2017
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Last Update Date | 01/17/2020
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Provider Practice Location Address
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Address Line | 1060 COUNTRY CLUB RD STE 101D
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City | SAINT CHARLES
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State | MO
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Zip | 63303-3373
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Country | US
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Telephone | 636-200-3454
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Fax | 844-208-9607
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Provider Business Mailing Address
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Address Line | 1060 COUNTRY CLUB RD STE 101D
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City | SAINT CHARLES
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State | MO
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Zip | 63303-3373
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Country | US
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Telephone | 636-200-3454
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Fax | 844-208-9607
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2015013269
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License Number State | MO
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