Provider Demographics
NPI:1720320237
Name:QUARLES, SHACARA
Entity Type:Individual
Prefix:
First Name:SHACARA
Middle Name:
Last Name:QUARLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 LAKE PLAZA DR STE 230
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3556
Mailing Address - Country:US
Mailing Address - Phone:719-287-8303
Mailing Address - Fax:
Practice Address - Street 1:1235 LAKE PLAZA DR STE 230
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3556
Practice Address - Country:US
Practice Address - Phone:719-287-8303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-13-14575103K00000X
CO0-13-5343103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst