Provider Demographics
NPI:1811360936
Name:MAX AH QUIN, LLC
Entity Type:Organization
Organization Name:MAX AH QUIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:
Authorized Official - Last Name:AH QUIN
Authorized Official - Suffix:
Authorized Official - Credentials:CMHC
Authorized Official - Phone:801-830-2889
Mailing Address - Street 1:511 W 630 S
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-6131
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3507 N UNIVERSITY AVE
Practice Address - Street 2:BUILDING 6, SUITE 350
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-4478
Practice Address - Country:US
Practice Address - Phone:801-830-2889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5847195-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty