| Doctor Name: | CARL DIXON QUEDENFELD |
| NPI Number: | 1265476949 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LMHC,LCSW |
| License Number: | 34002578A |
| Business Practice Address: | 7930 Valley Trace Lane Indpls, IN - 46237 |
| Business Phone Number: | 3172946216 |
| Business Fax Number: | |
| Mailing Address: | 8320 Madison Ave, INDPLS |
| State: | IN |
| Postal Code: | 46227 |
| Phone Number: | 3178825122 |
| Fax Number: | 3178888642 |
| NPI Enumeration Date: | 06/15/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 34002578A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |