Provider Demographics
NPI:1003695099
Name:HARTOUGH, NOEL JASON (LMHC)
Entity Type:Individual
Prefix:MR
First Name:NOEL
Middle Name:JASON
Last Name:HARTOUGH
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 W HIGHWAY 98 UNIT C53
Mailing Address - Street 2:
Mailing Address - City:PORT ST JOE
Mailing Address - State:FL
Mailing Address - Zip Code:32456-4724
Mailing Address - Country:US
Mailing Address - Phone:615-498-6435
Mailing Address - Fax:
Practice Address - Street 1:3050 W HIGHWAY 98 UNIT C53
Practice Address - Street 2:
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-4724
Practice Address - Country:US
Practice Address - Phone:615-498-6435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH22574101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty