Individual
JAHN QUATTLEBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6200 WILSHIRE DR, TYLER, TX 75703-4159
(903) 216-6641
Mailing address
6200 WILSHIRE DR, TYLER, TX 75703-4159
(903) 216-6641
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
12272
TX
101YM0800X
Mental Health Counselor
Primary
71752
TX
101YM0800X
Mental Health Counselor
LPC.0014807
CO
Other
Enumeration date
08/13/2018
Last updated
08/13/2018
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