Provider Demographics
NPI:1457819153
Name:QUAID, COLLEEN ELIZABETH ((T)LMFT)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ELIZABETH
Last Name:QUAID
Suffix:
Gender:F
Credentials:(T)LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:IA
Mailing Address - Zip Code:52228-9618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4403 1ST AVE SE STE 510
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3222
Practice Address - Country:US
Practice Address - Phone:319-551-4120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA093022106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist