Provider Demographics
NPI:1013059617
Name:QUAYLE, DEBRA V (MFT)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:V
Last Name:QUAYLE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 NW MEDICAL LOOP STE E
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-5545
Mailing Address - Country:US
Mailing Address - Phone:541-900-4285
Mailing Address - Fax:888-810-2993
Practice Address - Street 1:755 E 2ND AVE
Practice Address - Street 2:SUITE 2D
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5498
Practice Address - Country:US
Practice Address - Phone:970-570-7309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1017106H00000X
ORT1562106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORT1562OtherSTATE LICENSES MARRIAGE AND FAMILY THERAPIST