Provider Demographics
NPI:1922594027
Name:QUAIL SPRINGS COUNSELING PLLC
Entity Type:Organization
Organization Name:QUAIL SPRINGS COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. MARIE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-221-9590
Mailing Address - Street 1:15310 N MAY AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8864
Mailing Address - Country:US
Mailing Address - Phone:405-221-9590
Mailing Address - Fax:405-221-9591
Practice Address - Street 1:15310 N MAY AVE STE 202
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013
Practice Address - Country:US
Practice Address - Phone:405-221-9590
Practice Address - Fax:405-221-9591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-02
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6342101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty