MEDICARE: EDWARD NOLE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	5633	OK

General Provider Information

NPI Number	:	1497261135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD NOLE LPC

Provider Business Mailing Address
First Line	:	4912 E 22ND ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74114-2206
Country	:	US
Telephone Number	:	918-694-6653
Fax Number	:

Provider Business Practice Location Address
First Line	:	4912 E 22ND ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74114-2206
Country	:	US
Telephone Number	:	918-694-6653
Fax Number	:	918-694-6653

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2017
Last Update Date	:	12/18/2017

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Directions to “ EDWARD NOLE LPC” Practice Location

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