Provider Demographics
NPI:1851863690
Name:SQ THERAPY PLLC
Entity Type:Organization
Organization Name:SQ THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:YAMEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDOVAL QUIJANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-730-1788
Mailing Address - Street 1:609 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1142
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:609 W 18TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1142
Practice Address - Country:US
Practice Address - Phone:512-730-1788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty