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General NPI Number Information
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NPI Number | 1083730147
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Entity Type | Individual
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Provider Name | THERESA QUINN A.T.R., L.M.F.T.
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Gender | Female
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 03/02/2017
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Provider Practice Location Address
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Address Line | 17340 W 12 MILE RD #105
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City | SOUTHFIELD
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State | MI
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Zip | 48076-2122
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Country | US
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Telephone | 248-933-7029
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Fax |
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Provider Business Mailing Address
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Address Line | 31182 W RUTLAND ST
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City | BEVERLY HILLS
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State | MI
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Zip | 48025-5428
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Country | US
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Telephone | 248-885-8162
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4101006377
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License Number State | MI
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