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General NPI Number Information
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NPI Number | 1881276996
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Entity Type | Individual
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Provider Name | RAEGAN LASHAWN QUATTLEBAUM
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Gender | Female
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Dates
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Enumeration Date | 04/27/2021
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 16199 GREEN VALLEY RANCH BLVD APT 3024
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City | DENVER
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State | CO
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Zip | 80239-5727
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Country | US
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Telephone | 303-856-6125
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Fax |
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Provider Business Mailing Address
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Address Line | 18444 E 54TH AVE
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City | DENVER
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State | CO
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Zip | 80249-8794
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Country | US
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Telephone | 303-856-6125
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC.0020852
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License Number State | CO
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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 | LPC.0020852
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License Number State | CO
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