Provider Demographics
NPI:1376759126
Name:QUENNELL, COLIN DOUGLAS (LMFT)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:DOUGLAS
Last Name:QUENNELL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 ZINNIA CT
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-9647
Mailing Address - Country:US
Mailing Address - Phone:805-929-6532
Mailing Address - Fax:
Practice Address - Street 1:1106 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-2516
Practice Address - Country:US
Practice Address - Phone:805-473-7080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32602106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist