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General NPI Number Information
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NPI Number | 1316274681
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Entity Type | Organization
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Legal Business Name | QUEST SEXUALITY SPECIFIC SERVICES
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Dates
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Enumeration Date | 11/07/2009
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Last Update Date | 11/07/2009
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Provider Practice Location Address
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Address Line | 25 7TH ST W
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City | SAINT PAUL
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State | MN
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Zip | 55102-1103
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Country | US
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Telephone | 651-266-5208
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Fax |
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Provider Business Mailing Address
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Address Line | 25 7TH ST W
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City | SAINT PAUL
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State | MN
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Zip | 55102-1103
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Country | US
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Telephone | 651-266-5208
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | MR. BRIAN PORTZEN
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Credential |
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Telephone | 651-266-5206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 16439
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License Number State | MN
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