Provider Demographics
NPI:1912241233
Name:NOELCK, KATIE J (NLC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:J
Last Name:NOELCK
Suffix:
Gender:F
Credentials:NLC
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:J
Other - Last Name:RICKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NLC
Mailing Address - Street 1:3076 ELK RUN DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5385
Mailing Address - Country:US
Mailing Address - Phone:802-999-8289
Mailing Address - Fax:
Practice Address - Street 1:1283 DEER VALLEY DR
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-5182
Practice Address - Country:US
Practice Address - Phone:802-999-8289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0011830101YM0800X
UT11486762-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health