Provider Demographics
NPI:1538824446
Name:QUINN, COURTNEY CHRYSTAL (MA, MS, BCBA LBS)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:CHRYSTAL
Last Name:QUINN
Suffix:
Gender:F
Credentials:MA, MS, BCBA LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4871 VERA CRUZ RD
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-9553
Mailing Address - Country:US
Mailing Address - Phone:484-629-3496
Mailing Address - Fax:
Practice Address - Street 1:4871 VERA CRUZ RD
Practice Address - Street 2:
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049-9553
Practice Address - Country:US
Practice Address - Phone:484-629-3496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-21-54600103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty