Provider Demographics
NPI:1689952467
Name:QCCOUNSELOR
Entity Type:Organization
Organization Name:QCCOUNSELOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MARTENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS ED
Authorized Official - Phone:563-639-4359
Mailing Address - Street 1:2028 E 38TH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-1168
Mailing Address - Country:US
Mailing Address - Phone:563-639-4359
Mailing Address - Fax:
Practice Address - Street 1:2028 E 38TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-1168
Practice Address - Country:US
Practice Address - Phone:563-639-4359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00728251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health