Theresa L Qualls

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

P1204052 Issued in AR

Practice address

4 Shackleford PLZ
Suite 204
Little Rock, AR 72211-1826

Phone

(501) 410-7922

NPI assigned

Oct 11, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413158400000",
    "number": "1376731539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 N CEDAR ST",
            "address_2": "APT 1B",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722053924",
            "telephone_number": "501-410-7922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 SHACKLEFORD PLZ",
            "address_2": "SUITE 204",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722111826",
            "telephone_number": "501-410-7922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUALLS",
        "first_name": "THERESA",
        "middle_name": "L",
        "name_prefix": "Miss",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-11",
        "last_updated": "2014-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AR",
            "license": "P1204052",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AR",
            "license": "P1204052",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "AR",
            "license": "P1204052",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200023740",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mark Quarles, CRT
• Gayle Quattlebaum, P.T.
• Sarah Hope Quattlebaum, PHARMD
• Quest Middle School of West Little Rock

• Professional Counselor in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Professional Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.