Provider Demographics
NPI:1881792331
Name:QUALLS, SARA (PHD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:QUALLS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 N. HANCOCK
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903
Mailing Address - Country:US
Mailing Address - Phone:719-471-4884
Mailing Address - Fax:719-471-2800
Practice Address - Street 1:1436 N. HANCOCK
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903
Practice Address - Country:US
Practice Address - Phone:719-471-4884
Practice Address - Fax:719-471-2800
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist