MEDICARE: MICHAEL KEVIN NOLD MA, MFT

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	106H00000X	Marriage & Family Therapist	41834	CA

General Provider Information

NPI Number	:	1811187495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL KEVIN NOLD MA, MFT

Provider Business Mailing Address
First Line	:	1907 RICHMOND DR NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-1728
Country	:	US
Telephone Number	:	510-501-1167
Fax Number	:

Provider Business Practice Location Address
First Line	:	1907 RICHMOND DR NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-1728
Country	:	US
Telephone Number	:	510-501-1167
Fax Number	:

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

Provider Enumeration Date	:	07/30/2007
Last Update Date	:	07/22/2022

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