Healthcare Provider Details

I. General information

NPI: 1851592083
Provider Name (Legal Business Name): QUENTIN DOYLE MAXWELL PLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 S JEFFERSON AVE SUITE J
LEBANON MO
65536-3226
US

IV. Provider business mailing address

411 BECKETT ST
LEBANON MO
65536-3131
US

V. Phone/Fax

Practice location:
  • Phone: 417-588-2933
  • Fax: 417-588-2375
Mailing address:
  • Phone: 417-588-9183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2006033182
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: