Provider Demographics
NPI:1346246246
Name:MCINTYRE, CHERYL M (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:M
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 COFFMAN ST
Mailing Address - Street 2:STE 204
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-5445
Mailing Address - Country:US
Mailing Address - Phone:720-304-0460
Mailing Address - Fax:720-494-7713
Practice Address - Street 1:500 COFFMAN ST
Practice Address - Street 2:STE 204
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-5445
Practice Address - Country:US
Practice Address - Phone:720-304-0460
Practice Address - Fax:720-494-7713
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2481101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO537468Medicare ID - Type Unspecified