Provider Demographics
NPI:1164737664
Name:MCINTYRE, KAREN BETH (MA)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:BETH
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:674 COUNTY SQUARE DR STE 307
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-0451
Mailing Address - Country:US
Mailing Address - Phone:805-654-1840
Mailing Address - Fax:805-650-8211
Practice Address - Street 1:674 COUNTY SQUARE DR STE 307
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-0451
Practice Address - Country:US
Practice Address - Phone:805-654-1840
Practice Address - Fax:805-650-8211
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49134106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAIMF49434OtherCA BOARD OF BEHAVIORAL SCIENCES