Provider Demographics
NPI:1962059188
Name:VENABLES, NOAH CHARLES (PHD)
Entity type:Individual
Prefix:DR
First Name:NOAH
Middle Name:CHARLES
Last Name:VENABLES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13570 GROVE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-4400
Mailing Address - Country:US
Mailing Address - Phone:612-612-2728
Mailing Address - Fax:855-702-2517
Practice Address - Street 1:6800 FRANCE AVENUE SOUTH
Practice Address - Street 2:SUITE 300
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:612-276-2628
Practice Address - Fax:855-702-2517
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-22
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
MNLP6818103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologist