Provider Demographics
NPI:1972976082
Name:AH QUIN, MAX (CMHC)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:
Last Name:AH QUIN
Suffix:
Gender:M
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:801-830-2889
Mailing Address - Fax:
Practice Address - Street 1:3507 N UNIVERSITY AVE
Practice Address - Street 2: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:
Is Sole Proprietor?:Yes
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?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health