Provider Demographics
NPI:1417521246
Name:MCINTYRE, BRIAN HOWARD
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:HOWARD
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 BUSHY FORK RD
Mailing Address - Street 2:
Mailing Address - City:HURDLE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:27541-7645
Mailing Address - Country:US
Mailing Address - Phone:336-214-6759
Mailing Address - Fax:
Practice Address - Street 1:515 CARVER DR
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-0007
Practice Address - Country:US
Practice Address - Phone:336-599-9931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16495101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health