Provider Demographics
NPI:1730736430
Name:QUALLS & ASSOCIATES PLLC
Entity type:Organization
Organization Name:QUALLS & ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:QUALLS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:616-935-1246
Mailing Address - Street 1:923 S BEECHTREE ST STE 10
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2306
Mailing Address - Country:US
Mailing Address - Phone:616-935-1246
Mailing Address - Fax:616-935-1255
Practice Address - Street 1:923 S BEECHTREE ST STE 10
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2306
Practice Address - Country:US
Practice Address - Phone:616-935-1246
Practice Address - Fax:616-935-1255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty