Provider Demographics
NPI:1376689836
Name:MCINTOSH, ANNIE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 ELK RANGE RD
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-9624
Mailing Address - Country:US
Mailing Address - Phone:970-379-6381
Mailing Address - Fax:970-963-8486
Practice Address - Street 1:826 1 2 GRAND AVENUE
Practice Address - Street 2:SUITE 1
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601
Practice Address - Country:US
Practice Address - Phone:970-379-6381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3912101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional