Provider Demographics
NPI:1205213857
Name:MCINTOSH, BRANDON (LCSW)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:MCINTOSH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 1/2 MAIN ST STE 7
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-1870
Mailing Address - Country:US
Mailing Address - Phone:208-413-9973
Mailing Address - Fax:
Practice Address - Street 1:609 BRYDEN AVE STE B
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-5193
Practice Address - Country:US
Practice Address - Phone:208-413-9973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-04
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-355231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical