1023340585 NPI number — DR. DOUGLAS TYRONE LIVINGSTON QUINN PSYD, LMFT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023340585 NPI number — DR. DOUGLAS TYRONE LIVINGSTON QUINN PSYD, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIVINGSTON QUINN
Provider First Name:
DOUGLAS
Provider Middle Name:
TYRONE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD, LMFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
QUINN
Provider Other First Name:
DOUGLAS
Provider Other Middle Name:
TYRONE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSYD, LMFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023340585
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
411 VINEWOOD CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUISUN CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94585-1784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 VINEWOOD CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUISUN CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94585-1784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-656-9419
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/09/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC 45338 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MFC 45338 . This is a "CALIFORNIA BOARD OF BEHAVIORAL SCIENCES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".