Active NPI
Marc A Quillen, PH.D
- Clinical Psychologist
- Lawrence, KS
National Provider Identifier
1427053784
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 0521
- Practice address
- 4217 Briarwood Dr
Lawrence, KS 66049-1998 - Phone
- (785) 856-0684
- NPI assigned
- Jun 14, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 0521 | KS | |
| Clinical Psychologist | 103TC0700X | 0521 | KS | Primary |
Addresses
Primary practice location
4217 Briarwood Dr
Lawrence, KS 66049-1998
Mailing address
4217 Briarwood Dr
Lawrence, KS 66049-1998
Phone (785) 856-0684
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100230310B | Medicaid | KS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0521 | KS | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1237766400000",
"number": "1427053784",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4217 BRIARWOOD DR",
"city": "LAWRENCE",
"state": "KS",
"postal_code": "660491998",
"telephone_number": "785-856-0684"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4217 BRIARWOOD DR",
"city": "LAWRENCE",
"state": "KS",
"postal_code": "660491998",
"telephone_number": "785-856-0684"
}
],
"practiceLocations": [],
"basic": {
"last_name": "QUILLEN",
"first_name": "MARC",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "PH.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-06-14",
"last_updated": "2009-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "KS",
"license": "0521",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "KS",
"license": "0521",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100230310B",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lawrence, KS
- Qualicare Inc
- Kayleb Marley Qualls
- Quantum Shift Physical Therapy and Wellness Center LLC
- Sara Ann Quick, M.ED.
- Shari Quick, M.D.
- Warren Lee Quillin, PHARMD
- Alex William Quinn, DNAP, CRNA
- R. Michael McBride, DDS, PA (R. Mike McBride, DDS, PA)
- Radiation Oncologists PC
- Radiologic Professional Services. P.a.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.