Doctor Name: | MR. OLIVER A QUAYLE |
NPI Number: | 1366417511 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LIC PSY. MA & LCMHC |
License Number: | 047-0000664 |
Business Practice Address: | 107 Fisher Pond Rd St Albans, VT - 054786286 |
Business Phone Number: | 8025246555 |
Business Fax Number: | 8025246562 |
Mailing Address: | 322 Terrace Dr, WILLISTON |
State: | VT |
Postal Code: | 054952130 |
Phone Number: | 8028786355 |
Fax Number: | |
NPI Enumeration Date: | 02/21/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC1900X |
License Number: | 047-0000664 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Counseling |
Taxonomy Definition: |