Provider Demographics
NPI:1568991271
Name:NOBLE PATH WELLNESS, LLC
Entity Type:Organization
Organization Name:NOBLE PATH WELLNESS, LLC
Other - Org Name:NOBLE PATH COACHING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING OWNER / HEALTH COACH
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPA, CHC
Authorized Official - Phone:888-775-1589
Mailing Address - Street 1:677 WOODLAND SQUARE LOOP SE STE D5
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1000
Mailing Address - Country:US
Mailing Address - Phone:888-775-1589
Mailing Address - Fax:
Practice Address - Street 1:677 WOODLAND SQUARE LOOP SE STE D5
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1000
Practice Address - Country:US
Practice Address - Phone:888-775-1589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty