=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619430519
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLES L QUINN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2019
-----------------------------------------------------
Last Update Date | 01/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | HOPE CONNECTIONS LLC 704 HISTORIC RTE. 66W SUITE 101
-----------------------------------------------------
City | WAYNESVILLE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65583
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-452-1311
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | HOPE CONNECTIONS LLC 704 HISTORIC RTE. 66W SUITE 101
-----------------------------------------------------
City | WAYNESVILLE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65583
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-452-1311
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 2019009356
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 2019009356
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------