Provider Demographics
NPI:1356681191
Name:NOBLE, TAKIYAH ASHA
Entity Type:Individual
Prefix:
First Name:TAKIYAH
Middle Name:ASHA
Last Name:NOBLE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TAKIYAH
Other - Middle Name:ASHA
Other - Last Name:BUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2205 SPANISH TOWN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-0903
Mailing Address - Country:US
Mailing Address - Phone:702-505-6623
Mailing Address - Fax:
Practice Address - Street 1:2205 SPANISH TOWN AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-0903
Practice Address - Country:US
Practice Address - Phone:702-505-6623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health