MEDICARE: MRS. AMY LYNN QUILLIN M.A., NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	67033	TX

General Provider Information

NPI Number	:	1568716611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY LYNN QUILLIN M.A., NCC

Provider Business Mailing Address
First Line	:	19115 FM 2252
Second Line	:	SUITE 12
City	:	SAN ANTONIO
State	:	TX
Zip	:	78266-2577
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19115 FM 2252
Second Line	:	SUITE 12
City	:	SAN ANTONIO
State	:	TX
Zip	:	78266-2577
Country	:	US
Telephone Number	:	210-236-7768
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2012
Last Update Date	:	10/27/2012

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