Provider Demographics
NPI:1902559966
Name:QUINTANAR, KELLY (LAMFT-T)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:QUINTANAR
Suffix:
Gender:F
Credentials:LAMFT-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 E INDIGO BRUSH RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-4342
Mailing Address - Country:US
Mailing Address - Phone:602-750-2732
Mailing Address - Fax:
Practice Address - Street 1:8149 N 87TH PL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4399
Practice Address - Country:US
Practice Address - Phone:480-382-1796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist