Individual
MS. STACY QUINT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 412-1251
Mailing address
2608 PEACH GROVE LN, WOODLAWN, TN 37191-9354
(812) 454-4884
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20041873A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000300322
ANTHEM PROVIDER NUMBER
IN
05
—
200450480
—
IN
01
—
585677000
MAGELLAN HEALTH PROVIDER
IN
Enumeration date
05/28/2006
Last updated
05/07/2018
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