Provider Demographics
NPI:1033315262
Name:QUINLAN, KATHY LEE (IMF)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:LEE
Last Name:QUINLAN
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 271673
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94527-1673
Mailing Address - Country:US
Mailing Address - Phone:925-706-8477
Mailing Address - Fax:925-706-0285
Practice Address - Street 1:315 G ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-1254
Practice Address - Country:US
Practice Address - Phone:925-706-8477
Practice Address - Fax:925-706-0285
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 42900106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist