Provider Demographics
NPI:1003584848
Name:QUARLES, TINA MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:QUARLES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 COLLEGE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1615
Mailing Address - Country:US
Mailing Address - Phone:913-283-7704
Mailing Address - Fax:913-283-8537
Practice Address - Street 1:5400 COLLEGE BLVD STE B
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1615
Practice Address - Country:US
Practice Address - Phone:913-283-7704
Practice Address - Fax:913-283-8537
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-04
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11488104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker