Provider Demographics
NPI:1275907974
Name:QUAD CITIES THERAPY CENTER, LLC
Entity Type:Organization
Organization Name:QUAD CITIES THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MSW, LGSW
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LARRABEE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LGSW
Authorized Official - Phone:218-391-5653
Mailing Address - Street 1:8355 UNITY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-4061
Mailing Address - Country:US
Mailing Address - Phone:218-749-3107
Mailing Address - Fax:218-249-0787
Practice Address - Street 1:8355 UNITY DR STE 300
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-4061
Practice Address - Country:US
Practice Address - Phone:218-749-3107
Practice Address - Fax:218-249-0787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24499261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)