Provider Demographics
NPI:1306597992
Name:MAIRE, NOELLE
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:
Last Name:MAIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 E PARK ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-4598
Mailing Address - Country:US
Mailing Address - Phone:512-588-1362
Mailing Address - Fax:
Practice Address - Street 1:1524 LEANDER RD BLDG E
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-8801
Practice Address - Country:US
Practice Address - Phone:512-493-4473
Practice Address - Fax:512-777-5042
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
TX103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician