Provider Demographics
NPI:1235286873
Name:QUINT, EDWARD ALLEN
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:ALLEN
Last Name:QUINT
Suffix:
Gender:M
Credentials:
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 105
Mailing Address - Street 2:
Mailing Address - City:BARODA
Mailing Address - State:MI
Mailing Address - Zip Code:49101-0105
Mailing Address - Country:US
Mailing Address - Phone:269-422-2120
Mailing Address - Fax:
Practice Address - Street 1:497 E SHAWNEE RD
Practice Address - Street 2:
Practice Address - City:BARODA
Practice Address - State:MI
Practice Address - Zip Code:49101-8710
Practice Address - Country:US
Practice Address - Phone:269-422-2120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401002715101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional