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General NPI Number Information
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NPI Number | 1861680191
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Entity Type | Individual
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Provider Name | JOANN S QUINTERO PHD
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Gender | Female
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Dates
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Enumeration Date | 10/11/2007
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Last Update Date | 06/19/2018
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Provider Practice Location Address
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Address Line | 650 JOEL DR
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City | FORT CAMPBELL
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State | KY
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Zip | 42223
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Country | US
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Telephone | 270-798-5931
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Fax | 270-798-6037
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Provider Business Mailing Address
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Address Line | 1422 LAKEVIEW RD
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City | CLARKSVILLE
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State | TN
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Zip | 37040-6825
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Country | US
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Telephone | 615-202-0623
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 2809
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License Number State | TN
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