Provider Demographics
NPI:1982342291
Name:QUARRELL, KATHY (CPSW)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:QUARRELL
Suffix:
Gender:F
Credentials:CPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-4149
Mailing Address - Country:US
Mailing Address - Phone:575-956-7333
Mailing Address - Fax:575-936-4251
Practice Address - Street 1:117 E BIRCH ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-4148
Practice Address - Country:US
Practice Address - Phone:575-936-4177
Practice Address - Fax:575-936-4177
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1331101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1331Medicaid