Provider Demographics
NPI:1851592083
Name:MAXWELL, QUENTIN DOYLE (PLPC)
Entity Type:Individual
Prefix:MR
First Name:QUENTIN
Middle Name:DOYLE
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 BECKETT ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-3131
Mailing Address - Country:US
Mailing Address - Phone:417-588-9183
Mailing Address - Fax:
Practice Address - Street 1:281 S JEFFERSON AVE
Practice Address - Street 2:SUITE J
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-3226
Practice Address - Country:US
Practice Address - Phone:417-588-2933
Practice Address - Fax:417-588-2375
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006033182101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional