Provider Demographics
NPI:1255486965
Name:MCINTYRE, NANETTE F (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:NANETTE
Middle Name:F
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 3893
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79116-3893
Mailing Address - Country:US
Mailing Address - Phone:806-331-4300
Mailing Address - Fax:806-467-9332
Practice Address - Street 1:3012 S.W. 26TH AVENUE
Practice Address - Street 2:SUITE 700
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109
Practice Address - Country:US
Practice Address - Phone:806-331-4300
Practice Address - Fax:806-467-9332
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15942101YP2500X
NM4265101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3991LCOtherBLUECROSS & BLUESHIELD