Provider Demographics
NPI:1700178365
Name:QUIRK, KELLEY MARIE (MHA, PHD)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:MARIE
Last Name:QUIRK
Suffix:
Gender:F
Credentials:MHA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3174 S LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2624
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3174 S LOGAN ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2624
Practice Address - Country:US
Practice Address - Phone:269-967-3722
Practice Address - Fax:270-351-8166
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0004510101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor