Provider Demographics
NPI:1316409360
Name:NOBLES, BRENT (PRS)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:NOBLES
Suffix:
Gender:M
Credentials:PRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1356 W 85TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-1878
Mailing Address - Country:US
Mailing Address - Phone:567-242-3352
Mailing Address - Fax:
Practice Address - Street 1:4705 STATE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-5244
Practice Address - Country:US
Practice Address - Phone:440-468-6550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.169978251S00000X
OH006748175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No251S00000XAgenciesCommunity/Behavioral Health