Provider Demographics
NPI:1346719853
Name:QUINBY, BEVERLY LYNN
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:LYNN
Last Name:QUINBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 W JAMES ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-4487
Mailing Address - Country:US
Mailing Address - Phone:206-477-2894
Mailing Address - Fax:253-373-0129
Practice Address - Street 1:620 W JAMES ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-4487
Practice Address - Country:US
Practice Address - Phone:206-477-2894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
WACP00006422101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)