Provider Demographics
NPI:1265084651
Name:GAHAGAN, QUINTRELLA QUINTE' (LPC INTERN)
Entity type:Individual
Prefix:MRS
First Name:QUINTRELLA
Middle Name:QUINTE'
Last Name:GAHAGAN
Suffix:
Gender:F
Credentials:LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14600 MARSH LN APT 1108
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-5510
Mailing Address - Country:US
Mailing Address - Phone:972-385-3381
Mailing Address - Fax:
Practice Address - Street 1:14600 MARSH LN APT 1108
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-5510
Practice Address - Country:US
Practice Address - Phone:972-385-3381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79271101YP2500X
TX101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool