Provider Demographics
NPI:1477163319
Name:ACTION POTENTIAL BEHAVIORAL HEALTH AND SPORT PSYCHOLOGY, PLLC
Entity Type:Organization
Organization Name:ACTION POTENTIAL BEHAVIORAL HEALTH AND SPORT PSYCHOLOGY, PLLC
Other - Org Name:ACTION POTENTIAL BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACINTIRE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:970-609-9810
Mailing Address - Street 1:181 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2127
Mailing Address - Country:US
Mailing Address - Phone:970-609-9810
Mailing Address - Fax:
Practice Address - Street 1:181 ELM AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2127
Practice Address - Country:US
Practice Address - Phone:970-609-9810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-05
Last Update Date:2023-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty