Provider Demographics
NPI:1730124264
Name:NOLL, JAMES P (PHD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:P
Last Name:NOLL
Suffix:
Gender:M
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-1576
Mailing Address - Country:US
Mailing Address - Phone:574-732-1414
Mailing Address - Fax:574-732-0504
Practice Address - Street 1:1807 SMITH ST
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-1576
Practice Address - Country:US
Practice Address - Phone:574-732-1414
Practice Address - Fax:574-732-0504
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041539A103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000184327OtherANTHEM
IN000000184327OtherANTHEM