Provider Demographics
NPI:1538233036
Name:QUINN, TIMOTHY (MFT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:QUINN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:568 MANZANITA AVE
Mailing Address - Street 2:STE 6
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1361
Mailing Address - Country:US
Mailing Address - Phone:530-518-1782
Mailing Address - Fax:530-894-1382
Practice Address - Street 1:568 MANZANITA AVE
Practice Address - Street 2:STE 6
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1361
Practice Address - Country:US
Practice Address - Phone:530-518-1782
Practice Address - Fax:530-894-1382
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29777106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA29777OtherMFC