Provider Demographics
NPI:1477552966
Name:QUINN, JAMES B (PHD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:QUINN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:777 WALTER REED BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5727
Mailing Address - Country:US
Mailing Address - Phone:972-487-0790
Mailing Address - Fax:972-494-3062
Practice Address - Street 1:777 WALTER REED BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5727
Practice Address - Country:US
Practice Address - Phone:972-487-0790
Practice Address - Fax:972-494-3062
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23097103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00DX33Medicare PIN
TX57413Medicare UPIN