Individual provider Active NPI

M. Theresa Quinn, P.H.D.

  • Clinical Psychologist
  • College Station, TX
National Provider Identifier
1437110194
Registry record updated Jul 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
30885 Issued in TX
Practice address
1600 University Dr E
College Station, TX 77840-2642
Phone
(409) 691-3300
NPI assigned
Mar 31, 2006
Last updated
Jul 11, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 30885 TX Primary

Addresses

Primary practice location

1600 University Dr E
College Station, TX 77840-2642

Mailing address

PO Box 847408
Dallas, TX 75284-7408
Phone (254) 724-2111

Other identifiers 3

IdentifierTypeStateIssuer
0408585-01MedicaidTX
680012708OtherTXRR/MEDICARE
86346AOtherTXBLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100528000402 TX Practitioner - Clinical Psychologist 9436290509 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Aap - Psychology PLLCGroup PAC ID 1153361613, 3 clinicians

Practice addresses (Care Compare)

408 Tarrow St
College Station, TX 77840-7811
Phone 9792681111812

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
30885TXMDClinical Psychologist

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184112000000",
    "number": "1437110194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 847408",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752847408",
            "telephone_number": "254-724-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 UNIVERSITY DR E",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778402642",
            "telephone_number": "409-691-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUINN",
        "first_name": "M.",
        "middle_name": "THERESA",
        "name_prefix": "Dr.",
        "credential": "P.H.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-31",
        "last_updated": "2007-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "30885",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0408585-01",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR/MEDICARE",
            "identifier": "680012708",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "86346A",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in College Station, TX

Sources for this page

Verify at the official NPI Registry.