Provider Demographics
NPI:1134371404
Name:NOBLE, THEORA IRENE (MA, LPC, LPC S, LCDC)
Entity type:Individual
Prefix:MS
First Name:THEORA
Middle Name:IRENE
Last Name:NOBLE
Suffix:
Gender:F
Credentials:MA, LPC, LPC S, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 CASPER CT
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77302-3718
Mailing Address - Country:US
Mailing Address - Phone:936-689-5492
Mailing Address - Fax:
Practice Address - Street 1:404 W LEWIS ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-2568
Practice Address - Country:US
Practice Address - Phone:936-689-5492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-18
Last Update Date:2008-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX241101YA0400X
TX12088101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)