Provider Demographics
NPI:1598867004
Name:QUINN, BRUCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:QUINN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:G. (GARY)
Other - Middle Name:BRUCE
Other - Last Name:QUINN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:550 MAIN ST
Mailing Address - Street 2:SUITE 2 C
Mailing Address - City:DIAMOND SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95619-9177
Mailing Address - Country:US
Mailing Address - Phone:530-622-8646
Mailing Address - Fax:530-642-0339
Practice Address - Street 1:550 MAIN ST
Practice Address - Street 2:SUITE 2 C
Practice Address - City:DIAMOND SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95619-9177
Practice Address - Country:US
Practice Address - Phone:530-622-8646
Practice Address - Fax:530-642-0339
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC18011106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist