Provider Demographics
NPI:1346646551
Name:NOEL, GERALD JAMES JR (MED)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:JAMES
Last Name:NOEL
Suffix:JR
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6270 LEHMAN DR
Mailing Address - Street 2:SUITE 200D
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1469
Mailing Address - Country:US
Mailing Address - Phone:719-238-1464
Mailing Address - Fax:
Practice Address - Street 1:6270 LEHMAN DR
Practice Address - Street 2:SUITE 200D
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1469
Practice Address - Country:US
Practice Address - Phone:719-238-1464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-15
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003627101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional