Provider Demographics
NPI:1760165039
Name:SPENCER VALLAIRE, QUINTARA
Entity Type:Individual
Prefix:
First Name:QUINTARA
Middle Name:
Last Name:SPENCER VALLAIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 W BAY AREA BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-2681
Mailing Address - Country:US
Mailing Address - Phone:260-337-3029
Mailing Address - Fax:
Practice Address - Street 1:1560 W BAY AREA BLVD STE 303
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-2681
Practice Address - Country:US
Practice Address - Phone:260-337-3029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX681701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical