Doctor Name: | COURTNEY QUAST |
NPI Number: | 1003200692 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC-IT, SAC-IT |
License Number: | 17387-130 |
Business Practice Address: | 1315 W Main St Watertown, WI - 530943564 |
Business Phone Number: | 9202614100 |
Business Fax Number: | |
Mailing Address: | 1315 W Main St, WATERTOWN |
State: | WI |
Postal Code: | 530943564 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 03/23/2015 |
NPI Last Update Date: | 03/23/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 17387-130 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |