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General NPI Number Information
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NPI Number | 1790810711
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Entity Type | Individual
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Provider Name | BENJAMIN V NOAH PHD
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Gender | Male
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 11/12/2010
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Provider Practice Location Address
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Address Line | 2929 MCLAINE RD SE
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City | ARDMORE
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State | OK
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Zip | 73401-9239
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Country | US
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Telephone | 580-677-9555
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 503
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City | MADILL
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State | OK
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Zip | 73446-0503
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Country | US
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Telephone | 580-677-9555
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3246
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License Number State | OK
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