Provider Demographics
NPI:1215169156
Name:NOLAND, BRIAN JOSEPH (PHD, LP)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:JOSEPH
Last Name:NOLAND
Suffix:
Gender:M
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 SKYLINE BLVD APT 125
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5632
Mailing Address - Country:US
Mailing Address - Phone:816-550-5672
Mailing Address - Fax:
Practice Address - Street 1:901 E 2ND ST STE 201
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502
Practice Address - Country:US
Practice Address - Phone:775-982-5000
Practice Address - Fax:775-982-3971
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9464101Y00000X
NE847103T00000X
NVPY0849103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470376606-31Medicaid
NE100261397-00Medicaid
NE470376606-24Medicaid
NE47037660639Medicaid