Provider Demographics
NPI:1508265703
Name:QUIJADA, CARLOS G SR (MS, LPC)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:G
Last Name:QUIJADA
Suffix:SR
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2851 S AVENUE B # 4
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7726
Mailing Address - Country:US
Mailing Address - Phone:928-376-0026
Mailing Address - Fax:928-782-2298
Practice Address - Street 1:1701 N DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AZ
Practice Address - Zip Code:85607-1019
Practice Address - Country:US
Practice Address - Phone:520-366-3133
Practice Address - Fax:520-364-2770
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-14543101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional