Provider Demographics
NPI:1144879958
Name:QUINTANA, BETTY JANE (LCSW)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:JANE
Last Name:QUINTANA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:J
Other - Last Name:LUJAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5504 MILRAY DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-3183
Mailing Address - Country:US
Mailing Address - Phone:915-217-5226
Mailing Address - Fax:
Practice Address - Street 1:9650 KENWORTHY ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-6011
Practice Address - Country:US
Practice Address - Phone:888-365-6271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX532421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX53242OtherLICENSE