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General NPI Number Information
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NPI Number | 1477413672
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Entity Type | Organization
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Legal Business Name | NOBLE JOURNEY LLC
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Dates
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Enumeration Date | 11/12/2025
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 6300 76TH ST STE 200
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City | KENOSHA
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State | WI
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Zip | 53142-4018
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Country | US
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Telephone | 262-960-1981
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Fax |
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Provider Business Mailing Address
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Address Line | 2800 E ENTERPRISE AVE STE 333
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City | APPLETON
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State | WI
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Zip | 54913-7889
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Country | US
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Telephone | 262-960-1981
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | DR. NYLES ANTONY JACKSON
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Credential | DSW, LCSW
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Telephone | 262-960-1981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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