Provider Demographics
NPI:1093142762
Name:QUISUMBING, COLLEEN (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:QUISUMBING
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:CALLAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:PO BOX 1546
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94042-1546
Mailing Address - Country:US
Mailing Address - Phone:669-225-8270
Mailing Address - Fax:
Practice Address - Street 1:355 W OLIVE AVE STE 209
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-7660
Practice Address - Country:US
Practice Address - Phone:669-225-8270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53094106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist