MEDICARE: QUITLEY MANUEL

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	101YM0800X	Mental Health Counselor	M11184	MS

General Provider Information

NPI Number	:	1750058723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUITLEY MANUEL

Provider Business Mailing Address
First Line	:	218 S DENTON RD
Second Line	:
City	:	NEW ALBANY
State	:	MS
Zip	:	38652-2810
Country	:	US
Telephone Number	:	662-598-8141
Fax Number	:

Provider Business Practice Location Address
First Line	:	218 S DENTON RD
Second Line	:
City	:	NEW ALBANY
State	:	MS
Zip	:	38652-2810
Country	:	US
Telephone Number	:	662-598-8141
Fax Number	:

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

Provider Enumeration Date	:	08/26/2021
Last Update Date	:	11/07/2025

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Directions to “ QUITLEY MANUEL ” Practice Location

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