Provider Demographics
NPI:1114787199
Name:LE NOIR, JUSTIN LYLE
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:LYLE
Last Name:LE NOIR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3813 C ST
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-9031
Mailing Address - Country:US
Mailing Address - Phone:360-924-1811
Mailing Address - Fax:
Practice Address - Street 1:120 NE 136TH AVE STE 220
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6951
Practice Address - Country:US
Practice Address - Phone:360-952-7060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician