Provider Demographics
NPI:1467807784
Name:MCINTYRE, NICOLE MARIE (LMFT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S RIVERFRONT DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-2473
Mailing Address - Country:US
Mailing Address - Phone:507-320-4795
Mailing Address - Fax:507-218-9977
Practice Address - Street 1:1400 S RIVERFRONT DR STE 200
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-2473
Practice Address - Country:US
Practice Address - Phone:507-320-4795
Practice Address - Fax:507-218-9977
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3625106H00000X, 106H00000X
MN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health