1518064096 NPI number — COLLEEN RAE MCQUAID CNS-PMH, BC

Table of content: COLLEEN RAE MCQUAID CNS-PMH, BC (NPI 1518064096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518064096 NPI number — COLLEEN RAE MCQUAID CNS-PMH, BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCQUAID
Provider First Name:
COLLEEN
Provider Middle Name:
RAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNS-PMH, BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518064096
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1612 ROBIN RD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PANTEGO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-688-7352
Provider Business Mailing Address Fax Number:
214-302-1441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4500 SOUTH LANCASTER ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-849-3597
Provider Business Practice Location Address Fax Number:
214-302-1441
Provider Enumeration Date:
09/19/2006

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: 364SP0808X , with the licence number:  255887 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0134143-01 . This is a "ANCC CERT. NO." identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 255887 . This is a "REGISTERED NSG LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 11712 . This is a "LPC LICENSE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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