Individual
CARLY R QUICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
QMHA
Contact information
Practice address
2145 CENTENNIAL PLZ, EUGENE, OR 97401-2474
(541) 912-4085
Mailing address
2145 CENTENNIAL PLZ, EUGENE, OR 97401-2474
(541) 912-4085
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
21-QMHA-R-1030
OR
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
OH
390200000X
Student in an Organized Health Care Education/Training Program
S.2001529-TRNE
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0350549
—
OH
05
—
1639231715
—
OR
Enumeration date
05/24/2019
Last updated
05/05/2021
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