Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 5493 | MN |
Y | 103G00000X | Clinical Psychologist | 5493 | MN |
Y | 103TC0700X | Clinical Psychologist | 5493 | MN |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 5493 | MN |
N | 103TF0000X | Family Psychologist | 5493 | MN |
N | 103TH0004X | Health Psychologist | 5493 | MN |
N | 103TP2701X | Group Psychotherapist | 5493 | MN |
NPI | 1295883734 |
---|---|
Provider Name | Dr. Quinn E Sullivan |
First Address | Saint Paul, MN 55108-1737 |
Second Address | Saint Paul, MN 55108-1737 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 04/06/2012 |