Healthcare Provider Details

I. General information

NPI: 1265276828
Provider Name (Legal Business Name): COURTNEY J QUINTERO LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5303 S CEDAR ST STE 2
LANSING MI
48911-3800
US

IV. Provider business mailing address

812 E JOLLY RD STE 210
LANSING MI
48910-6821
US

V. Phone/Fax

Practice location:
  • Phone: 517-346-8200
  • Fax: 517-346-8011
Mailing address:
  • Phone: 517-237-7350
  • Fax: 517-346-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851118035
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: