Provider Demographics
NPI:1760415970
Name:QUIGGLE, TIM (LMFT)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:QUIGGLE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S HOLLAND ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-2096
Mailing Address - Country:US
Mailing Address - Phone:316-440-8928
Mailing Address - Fax:316-440-8928
Practice Address - Street 1:520 S HOLLAND ST
Practice Address - Street 2:SUITE 103
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-2096
Practice Address - Country:US
Practice Address - Phone:316-440-8928
Practice Address - Fax:316-440-8928
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS661106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist