Provider Demographics
NPI:1518064096
Name:MCQUAID, COLLEEN RAE (CNS-PMH, BC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:RAE
Last Name:MCQUAID
Suffix:
Gender:F
Credentials:CNS-PMH, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 ROBIN RD.
Mailing Address - Street 2:
Mailing Address - City:PANTEGO
Mailing Address - State:TX
Mailing Address - Zip Code:76013
Mailing Address - Country:US
Mailing Address - Phone:817-688-7352
Mailing Address - Fax:214-302-1441
Practice Address - Street 1:4500 SOUTH LANCASTER ROAD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216
Practice Address - Country:US
Practice Address - Phone:800-849-3597
Practice Address - Fax:214-302-1441
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX255887364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0134143-01OtherANCC CERT. NO.
TX255887OtherREGISTERED NSG LICENSE
TX11712OtherLPC LICENSE NUMBER
TX0134143-01OtherANCC CERT. NO.