Provider Demographics
NPI:1588709299
Name:NOYES DEBORD, MARY PATRICIA
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:PATRICIA
Last Name:NOYES DEBORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PATTY
Other - Middle Name:
Other - Last Name:NOYES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS MFT LASW
Mailing Address - Street 1:4600 KIETZKE LN
Mailing Address - Street 2:SUITE C122
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502
Mailing Address - Country:US
Mailing Address - Phone:775-823-9133
Mailing Address - Fax:775-823-9240
Practice Address - Street 1:4600 KIETZKE LN
Practice Address - Street 2:SUITE C122
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502
Practice Address - Country:US
Practice Address - Phone:775-823-9133
Practice Address - Fax:775-823-9240
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00318A104100000X
NV0138106H00000X
NV6838163W00000X
CA227483163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV11363962Other1ST HEALTH
NV442458OtherVALU OPTIONS