Provider Demographics
NPI:1770168551
Name:QUINTON, TAMARA (LPC)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:QUINTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4543 FLORA DR
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-4563
Mailing Address - Country:US
Mailing Address - Phone:208-419-9424
Mailing Address - Fax:
Practice Address - Street 1:4543 FLORA DR
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-4563
Practice Address - Country:US
Practice Address - Phone:208-419-9424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-13
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID7658101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor