Quineiform LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

5493 Issued in MN

Legal business name

QUINEIFORM LLC

Practice address

8519 Eagle Point Blvd
Suite 150
Lake Elmo, MN 55042-8629

Phone

(651) 343-4800

Fax

(877) 992-0282

NPI assigned

Nov 10, 2014

Organization subpart

No

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

Authorized official

Name

Quinn Sullivan, PSYD

Title

Clinical Psychologist

Phone

(651) 343-4800

Specialties & licenses 1

Addresses

Other names 1

• Quinn Sullivan PsyD, LP Doing business as

Locations

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

{
    "created_epoch": "1415577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415577600000",
    "number": "1639575137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8519 EAGLE POINT BLVD",
            "address_2": "SUITE 150",
            "city": "LAKE ELMO",
            "state": "MN",
            "postal_code": "550428629",
            "telephone_number": "651-343-4800",
            "fax_number": "877-992-0282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8519 EAGLE POINT BLVD",
            "address_2": "SUITE 150",
            "city": "LAKE ELMO",
            "state": "MN",
            "postal_code": "550428629",
            "telephone_number": "651-343-4800",
            "fax_number": "877-992-0282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUINEIFORM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-10",
        "last_updated": "2014-11-10",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "QUINN",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "651-343-4800",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": "5493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Quinn Sullivan PsyD, LP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 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.