Basic Information
| Provider Information | |||||||||
| NPI: | 1922126846 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUINN | ||||||||
| FirstName: | STARLA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 421 ZANG ST | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802281052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039894357 | ||||||||
| FaxNumber: | 3039882017 | ||||||||
| Practice Location | |||||||||
| Address1: | 421 ZANG ST | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802281052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039894357 | ||||||||
| FaxNumber: | 3039882017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 08/05/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LPC-1741 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 71558560 | 05 | CO | MEDICAID |