Provider Demographics
NPI:1477906824
Name:QUAN, JEFFREY (LPC-S)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:QUAN
Suffix:
Gender:M
Credentials:LPC-S
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 3280
Mailing Address - Street 2:
Mailing Address - City:QUINLAN
Mailing Address - State:TX
Mailing Address - Zip Code:75474-0055
Mailing Address - Country:US
Mailing Address - Phone:972-345-9681
Mailing Address - Fax:
Practice Address - Street 1:4817 MEDICAL CENTER DR STE 3A
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1886
Practice Address - Country:US
Practice Address - Phone:972-607-9650
Practice Address - Fax:469-519-0423
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60655101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health