Provider Demographics
NPI:1063014777
Name:MCINTYRE, DODIE JANE
Entity Type:Individual
Prefix:
First Name:DODIE
Middle Name:JANE
Last Name:MCINTYRE
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:PO BOX 752
Mailing Address - Street 2:
Mailing Address - City:ERICK
Mailing Address - State:OK
Mailing Address - Zip Code:73645-0752
Mailing Address - Country:US
Mailing Address - Phone:580-729-0422
Mailing Address - Fax:
Practice Address - Street 1:100 S MONROE ST
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-5722
Practice Address - Country:US
Practice Address - Phone:580-729-0422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health