MEDICARE: QUINN LAUREN SMALLEY LMHC, ATR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH22253	FL

General Provider Information

NPI Number	:	1821780537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUINN LAUREN SMALLEY LMHC, ATR

Provider Business Mailing Address
First Line	:	990 VILLA ST
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94041-1236
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	817 SE 6TH CT
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-3115
Country	:	US
Telephone Number	:	954-560-3987
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2023
Last Update Date	:	05/22/2023

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