Provider Demographics
NPI:1780299859
Name:QUALLS, JUSTIN (LPC)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:QUALLS
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 LOCK AND DAM RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802-9725
Mailing Address - Country:US
Mailing Address - Phone:479-567-1864
Mailing Address - Fax:636-324-8551
Practice Address - Street 1:104 LOCK AND DAM RD
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72802-9725
Practice Address - Country:US
Practice Address - Phone:479-567-1864
Practice Address - Fax:636-324-8551
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ARA2009111101YM0800X
ARP2303003101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health