Provider Demographics
NPI:1720428303
Name:NOGUESS, JACQUES TANNER (LPC)
Entity type:Individual
Prefix:
First Name:JACQUES
Middle Name:TANNER
Last Name:NOGUESS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 LA MESA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-5428
Mailing Address - Country:US
Mailing Address - Phone:325-245-6551
Mailing Address - Fax:
Practice Address - Street 1:2711 LA MESA DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-5428
Practice Address - Country:US
Practice Address - Phone:512-730-1711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64978101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional