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General NPI Number Information
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NPI Number | 1730770330
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Entity Type | Organization
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Legal Business Name | SHAWN D QUINTANILLA DPC LPC LMFT PLLC
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Dates
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Enumeration Date | 01/27/2021
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Last Update Date | 01/27/2021
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Provider Practice Location Address
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Address Line | 2217 PARK AVE
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City | PEARLAND
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State | TX
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Zip | 77581-4216
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Country | US
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Telephone | 281-997-8400
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Fax | 281-997-8408
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Provider Business Mailing Address
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Address Line | 2217 PARK AVE
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City | PEARLAND
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State | TX
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Zip | 77581-4216
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Country | US
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Telephone | 281-997-8400
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Fax | 281-997-8408
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DR. SHAWN D QUINTANILLA
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Credential | DPC, LPC-S, LMFT
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Telephone | 281-997-8400
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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