Provider Demographics
NPI:1558438952
Name:QUAYLE, CHRISTIAN MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:MICHAEL
Last Name:QUAYLE
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Gender:M
Credentials:PHD
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Mailing Address - Street 1:15418 MAIN ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-9030
Mailing Address - Country:US
Mailing Address - Phone:425-385-3262
Mailing Address - Fax:425-357-0924
Practice Address - Street 1:15418 MAIN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-9030
Practice Address - Country:US
Practice Address - Phone:425-385-3262
Practice Address - Fax:425-357-0924
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAWA 1303103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7079452Medicaid