Provider Demographics
NPI:1215604749
Name:NOEL, KARLY LORAINE (BS, CADC-R, QMHA-R)
Entity Type:Individual
Prefix:
First Name:KARLY
Middle Name:LORAINE
Last Name:NOEL
Suffix:
Gender:F
Credentials:BS, CADC-R, QMHA-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 810
Mailing Address - Street 2:
Mailing Address - City:GOLD BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97444-0810
Mailing Address - Country:US
Mailing Address - Phone:541-425-7545
Mailing Address - Fax:541-813-2536
Practice Address - Street 1:615 5TH ST
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9199
Practice Address - Country:US
Practice Address - Phone:541-425-7545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR455252325Medicaid