Healthcare Provider Details

I. General information

NPI: 1902285786
Provider Name (Legal Business Name): THOMAS QUINN LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7850 JEFFERSON ST NE STE 300
ALBUQUERQUE NM
87109-4314
US

IV. Provider business mailing address

7850 JEFFERSON ST NE STE 300
ALBUQUERQUE NM
87109-4314
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-1114
  • Fax: 505-856-6320
Mailing address:
  • Phone: 505-884-1114
  • Fax: 505-856-6320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0173811
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCS001384
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: