Basic Information
| Provider Information | |||||||||
| NPI: | 1174825277 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NOE | ||||||||
| FirstName: | NEALY | ||||||||
| MiddleName: | EVE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MA, MFTI #64906 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2416 S MAIN ST UNIT B | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927073255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149669999 | ||||||||
| FaxNumber: | 7149669996 | ||||||||
| Practice Location | |||||||||
| Address1: | 2416 S MAIN ST UNIT B | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927073255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149669999 | ||||||||
| FaxNumber: | 7149669996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2010 | ||||||||
| LastUpdateDate: | 11/22/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MFTI 64906C | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.