Provider Demographics
NPI:1184393738
Name:SARA HONN QUALLS PHD LLC
Entity type:Organization
Organization Name:SARA HONN QUALLS PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:HONN
Authorized Official - Last Name:QUALLS
Authorized Official - Suffix:X
Authorized Official - Credentials:PHD
Authorized Official - Phone:719-428-5025
Mailing Address - Street 1:10 E MONUMENT ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1018
Mailing Address - Country:US
Mailing Address - Phone:719-428-5025
Mailing Address - Fax:719-896-5138
Practice Address - Street 1:10 E MONUMENT ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1018
Practice Address - Country:US
Practice Address - Phone:719-428-5025
Practice Address - Fax:719-896-5138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health