Tanya M. Qualls, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

PC012607 Issued in PA

Practice address

113 W Wayne Ave
Wayne, PA 19087-4099

Phone

(610) 687-6415

NPI assigned

May 25, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Kai Qualls Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Women'S Resource Center of the Delaware Valley

  • Professional Counselor
  • Wayne, PA
  • NPI 1639769151
  NPD

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

{
    "created_epoch": "1621900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621900800000",
    "number": "1497320089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 W WAYNE AVE",
            "city": "WAYNE",
            "state": "PA",
            "postal_code": "190874099",
            "telephone_number": "610-687-6415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 W WAYNE AVE",
            "city": "WAYNE",
            "state": "PA",
            "postal_code": "190874099",
            "telephone_number": "610-687-6415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUALLS",
        "first_name": "TANYA",
        "middle_name": "M.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-25",
        "last_updated": "2021-05-25",
        "certification_date": "2021-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "PA",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "PA",
            "license": "PC012607",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAI",
            "last_name": "QUALLS",
            "credential": "LPC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Professional Counselor in Wayne, PA
• Providers in Wayne, PA by specialty
• Professional Counselor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2021; 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.