Provider Demographics
NPI:1174291272
Name:NOBLE, KEVIN GEORGE (LAC, LMFT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:GEORGE
Last Name:NOBLE
Suffix:
Gender:M
Credentials:LAC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2927 E MARSON DR APT E
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-4730
Mailing Address - Country:US
Mailing Address - Phone:605-677-9402
Mailing Address - Fax:
Practice Address - Street 1:1310 W 51ST ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6606
Practice Address - Country:US
Practice Address - Phone:605-334-1414
Practice Address - Fax:605-335-3121
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD21011864101YA0400X
SDLMFT11564106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDLMFT11564OtherSD DEPARTMENT OF SOCIAL SERVICES BOARD OF EXAMINERS