Provider Demographics
NPI:1487374690
Name:NOEL, BRANDON JEVON
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:JEVON
Last Name:NOEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10265 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT ANN
Mailing Address - State:MO
Mailing Address - Zip Code:63074-3840
Mailing Address - Country:US
Mailing Address - Phone:910-548-3551
Mailing Address - Fax:
Practice Address - Street 1:3460 HAMPTON AVE STE 204
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-1938
Practice Address - Country:US
Practice Address - Phone:314-669-6242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health