Provider Demographics
NPI:1952599508
Name:QUILLIN, JANEL BOBBY
Entity Type:Individual
Prefix:
First Name:JANEL
Middle Name:BOBBY
Last Name:QUILLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BUTTERFLY COUNSELING
Other - Middle Name:
Other - Last Name:BUTTERFLY COUNSELING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3021 N 13TH ST
Mailing Address - Street 2:STE 3
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-1244
Mailing Address - Country:US
Mailing Address - Phone:812-229-6243
Mailing Address - Fax:
Practice Address - Street 1:3021 N 13TH ST
Practice Address - Street 2:STE 3
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-1244
Practice Address - Country:US
Practice Address - Phone:812-229-6243
Practice Address - Fax:812-213-4182
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33003656A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN111810MMMedicare PIN