Healthcare Provider Details

I. General information

NPI: 1982255170
Provider Name (Legal Business Name): CORY A QUINN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2019
Last Update Date: 09/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 STAFFORD WAY STE F
YUBA CITY CA
95991-3333
US

IV. Provider business mailing address

1108 IRONWOOD ST
PLUMAS LAKE CA
95961-8706
US

V. Phone/Fax

Practice location:
  • Phone: 530-434-6318
  • Fax:
Mailing address:
  • Phone: 530-301-2417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT113162
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: