Provider Demographics
NPI:1568078160
Name:MCINTIRE, CORI (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:CORI
Middle Name:
Last Name:MCINTIRE
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 TISBURY CT
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-1576
Mailing Address - Country:US
Mailing Address - Phone:304-482-8809
Mailing Address - Fax:
Practice Address - Street 1:385 W VETERANS MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-1066
Practice Address - Country:US
Practice Address - Phone:636-456-6984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018008853103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst