Provider Demographics
NPI:1558929505
Name:MACINTIRE, MAE (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:MAE
Middle Name:
Last Name:MACINTIRE
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2023-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0004962103TC0700X, 103TC0700X
COPSY0004962103T00000X, 103TE1100X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy