| Organization Name: | QUAD CITIES THERAPY CENTER, LLC |
| NPI Number: | 1275907974 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TERESA ANN LARRABEE (OWNER, MSW, LGSW) |
| Mailing Address: | 8355 Unity Dr Ste 300 Virginia |
| State: | MN US |
| Postal Code: | 557924061 |
| Phone Number: | 2187493107 |
| Fax Number: | 2182490787 |
| NPI Enumeration Date: | 11/18/2015 |
| NPI Last Update Date: | 11/18/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0801X |
| License Number: | 24499 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
| Taxonomy Definition: | |