Provider Demographics
NPI:1790810711
Name:NOAH, BENJAMIN V (PHD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:V
Last Name:NOAH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:BENJAMIN
Other - Middle Name:V
Other - Last Name:NOAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 503
Mailing Address - Street 2:
Mailing Address - City:MADILL
Mailing Address - State:OK
Mailing Address - Zip Code:73446-0503
Mailing Address - Country:US
Mailing Address - Phone:580-677-9555
Mailing Address - Fax:
Practice Address - Street 1:2929 MCLAINE RD SE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-9239
Practice Address - Country:US
Practice Address - Phone:580-677-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3246101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional