Provider Demographics
NPI:1629788724
Name:NOBLE, ETHAN BALDWIN (MA)
Entity type:Individual
Prefix:MR
First Name:ETHAN
Middle Name:BALDWIN
Last Name:NOBLE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22471 ASPAN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1644
Mailing Address - Country:US
Mailing Address - Phone:949-458-2715
Mailing Address - Fax:949-458-3583
Practice Address - Street 1:22471 ASPAN ST STE 103
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1644
Practice Address - Country:US
Practice Address - Phone:949-458-2715
Practice Address - Fax:949-458-3583
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA135939106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist