Provider Demographics
NPI:1790268381
Name:QUIGLEY, MANDI ELIZABETH (LLPC, TLLP, CAADC)
Entity Type:Individual
Prefix:
First Name:MANDI
Middle Name:ELIZABETH
Last Name:QUIGLEY
Suffix:
Gender:F
Credentials:LLPC, TLLP, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MI
Mailing Address - Zip Code:49078-9641
Mailing Address - Country:US
Mailing Address - Phone:616-644-4383
Mailing Address - Fax:
Practice Address - Street 1:343 S 16TH ST
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MI
Practice Address - Zip Code:49078-9641
Practice Address - Country:US
Practice Address - Phone:616-644-4383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015670101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional