Provider Demographics
NPI:1285160770
Name:NOLLE, JAIME MELISSA (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:JAIME
Middle Name:MELISSA
Last Name:NOLLE
Suffix:
Gender:F
Credentials:MA, LPC
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1060 COUNTRY CLUB RD STE 101D
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-3373
Mailing Address - Country:US
Mailing Address - Phone:636-200-3454
Mailing Address - Fax:844-208-9607
Practice Address - Street 1:1060 COUNTRY CLUB RD STE 101D
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-3373
Practice Address - Country:US
Practice Address - Phone:636-200-3454
Practice Address - Fax:844-208-9607
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2015013269101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional