Provider Demographics
NPI:1306276605
Name:TINNIN, QUASHAUNTAI TANYELLE
Entity type:Individual
Prefix:MRS
First Name:QUASHAUNTAI
Middle Name:TANYELLE
Last Name:TINNIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4037 FLOWER PATCH ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-2441
Mailing Address - Country:US
Mailing Address - Phone:702-762-4662
Mailing Address - Fax:
Practice Address - Street 1:4037 FLOWER PATCH ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-2441
Practice Address - Country:US
Practice Address - Phone:702-762-4662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health