Provider Demographics
NPI:1730770330
Name:SHAWN D QUINTANILLA DPC LPC LMFT PLLC
Entity type:Organization
Organization Name:SHAWN D QUINTANILLA DPC LPC LMFT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:D
Authorized Official - Last Name:QUINTANILLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPC, LPC-S, LMFT
Authorized Official - Phone:281-997-8400
Mailing Address - Street 1:2217 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-4216
Mailing Address - Country:US
Mailing Address - Phone:281-997-8400
Mailing Address - Fax:281-997-8408
Practice Address - Street 1:2217 PARK AVE
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-4216
Practice Address - Country:US
Practice Address - Phone:281-997-8400
Practice Address - Fax:281-997-8408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty