Provider Demographics
NPI:1962561217
Name:NOBLES, BRENDA H (PHD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:H
Last Name:NOBLES
Suffix:
Gender:F
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:PO BOX 824
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72018-0824
Mailing Address - Country:US
Mailing Address - Phone:501-315-1309
Mailing Address - Fax:501-315-1309
Practice Address - Street 1:1002 SCHNEIDER DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104
Practice Address - Country:US
Practice Address - Phone:501-315-1309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7519P103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR56342Medicare ID - Type Unspecified
R23682Medicare UPIN