Provider Demographics
NPI:1003920745
Name:MCINTYRE, DAVID J (PHD, ABPP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 S LAKESHORE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7052
Mailing Address - Country:US
Mailing Address - Phone:480-495-5685
Mailing Address - Fax:
Practice Address - Street 1:4500 S LAKESHORE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7052
Practice Address - Country:US
Practice Address - Phone:480-495-5685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3679103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ955619Medicaid
AZ955619Medicaid