Provider Demographics
NPI:1457684664
Name:QUILLE, TANYA JUSTYNE (PHD)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:JUSTYNE
Last Name:QUILLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N ZAPATA HWY STE 11
Mailing Address - Street 2:75 MB
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-4427
Mailing Address - Country:US
Mailing Address - Phone:443-477-0384
Mailing Address - Fax:410-583-2949
Practice Address - Street 1:2324 W JOPPA RD STE 220
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-4618
Practice Address - Country:US
Practice Address - Phone:434-770-3844
Practice Address - Fax:410-583-2949
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04599103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist