Provider Demographics
NPI:1073164968
Name:MACINTOSH, CATHERINE LEE (CADC INTERN)
Entity Type:Individual
Prefix:MISS
First Name:CATHERINE
Middle Name:LEE
Last Name:MACINTOSH
Suffix:
Gender:F
Credentials:CADC INTERN
Other - Prefix:MISS
Other - First Name:CATHERINELEE
Other - Middle Name:
Other - Last Name:MACINTOSH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1755 SULLIVAN LN
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-2815
Mailing Address - Country:US
Mailing Address - Phone:775-455-4260
Mailing Address - Fax:775-455-4259
Practice Address - Street 1:1755 SULLIVAN LN
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-2815
Practice Address - Country:US
Practice Address - Phone:775-455-4260
Practice Address - Fax:775-455-4259
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1205389129Medicaid