Provider Demographics
NPI:1295207801
Name:QUARLES, TERRENCE (BA)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:
Last Name:QUARLES
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WEST LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:VIVIAN
Mailing Address - State:LA
Mailing Address - Zip Code:71082
Mailing Address - Country:US
Mailing Address - Phone:318-375-2780
Mailing Address - Fax:318-375-2781
Practice Address - Street 1:200 WEST LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:VIVIAN
Practice Address - State:LA
Practice Address - Zip Code:71082
Practice Address - Country:US
Practice Address - Phone:318-375-2780
Practice Address - Fax:318-375-2781
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health