Provider Demographics
NPI:1073396958
Name:MCINTIRE, QUINN
Entity Type:Individual
Prefix:
First Name:QUINN
Middle Name:
Last Name:MCINTIRE
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 1:2539 N WATTS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-6367
Mailing Address - Country:US
Mailing Address - Phone:907-321-2456
Mailing Address - Fax:
Practice Address - Street 1:1600 SE ANKENY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1448
Practice Address - Country:US
Practice Address - Phone:503-236-7094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health