Provider Demographics
NPI:1447689435
Name:QUINE, AMANDA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:QUINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 N A ST
Mailing Address - Street 2:SUITE 7-260
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-5421
Mailing Address - Country:US
Mailing Address - Phone:432-470-4400
Mailing Address - Fax:432-570-4460
Practice Address - Street 1:3300 N A ST
Practice Address - Street 2:SUITE 7-260
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-5421
Practice Address - Country:US
Practice Address - Phone:432-470-4400
Practice Address - Fax:432-570-4460
Is Sole Proprietor?:No
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-13-14560103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst