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General NPI Number Information
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NPI Number | 1275911331
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Entity Type | Organization
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Legal Business Name | QUANTUM COUNSELING SERVICES
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Dates
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Enumeration Date | 05/11/2015
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Last Update Date | 05/11/2015
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Provider Practice Location Address
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Address Line | HOTEL JAMESTOWN BLDG 110 WEST THIRD STREET, SUITE 404
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City | JAMESTOWN
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State | NY
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Zip | 14701-5112
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Country | US
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Telephone | 716-640-2378
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Fax | 716-720-5880
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Provider Business Mailing Address
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Address Line | HOTEL JAMESTOWN BLDG 110 WEST THIRD STREET, SUITE 404
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City | JAMESTOWN
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State | NY
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Zip | 14701-5112
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Country | US
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Telephone | 716-640-2378
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Fax | 716-720-5880
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Authorized Official
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Title or Position | SUPERVISING SOCIAL WORKER OWNER
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Name | MR. ERIC GREGORY BRAUN
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Credential | MSW, LMSW, CDP, CCTP
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Telephone | 716-640-2378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 067782
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License Number State | NY
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