Provider Demographics
NPI:1689219826
Name:QUAD CITY PSYCHOTHERAPY, PLLC
Entity Type:Organization
Organization Name:QUAD CITY PSYCHOTHERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:O'MELIA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:309-235-8767
Mailing Address - Street 1:2550 MIDDLE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3287
Mailing Address - Country:US
Mailing Address - Phone:563-265-1529
Mailing Address - Fax:
Practice Address - Street 1:2513 24TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5305
Practice Address - Country:US
Practice Address - Phone:309-235-8767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty