Provider Demographics
NPI:1003340027
Name:NICHOLAS & NOBLE PSYCHOLOGICAL ASSOCIATES
Entity Type:Organization
Organization Name:NICHOLAS & NOBLE PSYCHOLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE NOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-677-7363
Mailing Address - Street 1:300 E. ROOSEVELT RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-1910
Mailing Address - Country:US
Mailing Address - Phone:773-677-7363
Mailing Address - Fax:
Practice Address - Street 1:300 E ROOSEVELT RD
Practice Address - Street 2:SUITE 105
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-1910
Practice Address - Country:US
Practice Address - Phone:773-677-7363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007387103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty