Provider Demographics
NPI:1851310932
Name:QUINLAN, HEIDI JO (LPC,LISAC, LAC, NCC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:JO
Last Name:QUINLAN
Suffix:
Gender:F
Credentials:LPC,LISAC, LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 E MCDOWELL RD STE 250
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-7725
Mailing Address - Country:US
Mailing Address - Phone:602-464-9576
Mailing Address - Fax:480-428-0475
Practice Address - Street 1:7400 S POWER RD STE 126
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-9283
Practice Address - Country:US
Practice Address - Phone:480-482-7350
Practice Address - Fax:480-482-7370
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-11631101Y00000X
AZLISAC-11071101YM0800X
AZLPC-13084101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ298896Medicaid