Provider Demographics
NPI:1730843285
Name:QUINTANA, MICHAEL JUSTIN (LMFT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JUSTIN
Last Name:QUINTANA
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 PALM BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-5431
Mailing Address - Country:US
Mailing Address - Phone:956-410-2802
Mailing Address - Fax:866-892-0888
Practice Address - Street 1:355 PALM BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-5431
Practice Address - Country:US
Practice Address - Phone:956-455-7811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204290106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX473397401Medicaid