Provider Demographics
NPI:1770936106
Name:QUIST, MARTA MARIA (LMFT)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:MARIA
Last Name:QUIST
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MOHAWK DR
Mailing Address - Street 2:
Mailing Address - City:CLARENDON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60514-1128
Mailing Address - Country:US
Mailing Address - Phone:847-606-5425
Mailing Address - Fax:
Practice Address - Street 1:1737 S NAPERVILLE RD
Practice Address - Street 2:206
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-5894
Practice Address - Country:US
Practice Address - Phone:630-653-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.000802101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor