Healthcare Provider Details

I. General information

NPI: 1235969163
Provider Name (Legal Business Name): QUIRK PSYCHOTHERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3174 S LOGAN ST
ENGLEWOOD CO
80113-2624
US

IV. Provider business mailing address

3174 S LOGAN ST
ENGLEWOOD CO
80113-2624
US

V. Phone/Fax

Practice location:
  • Phone: 269-967-3722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: KELLEY QUIRK
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 926-967-3722