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General NPI Number Information
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NPI Number | 1275781247
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Entity Type | Individual
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Provider Name | KRISTEN R QUALLS MA, LPC, LMFT, NCC
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Gender | Female
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 09/14/2018
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Provider Practice Location Address
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Address Line | 705 BARCLAY CIR STE 105
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-4575
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Country | US
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Telephone | 810-397-4861
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Fax |
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Provider Business Mailing Address
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Address Line | 705 BARCLAY CIR STE 105
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-4575
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Country | US
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Telephone | 810-397-4861
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6401011017
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License Number State | MI
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