Provider Demographics
NPI:1609001692
Name:MCINTIRE, SUZANN LYNN (MS)
Entity Type:Individual
Prefix:MRS
First Name:SUZANN
Middle Name:LYNN
Last Name:MCINTIRE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 FRANKLIN PL
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-1519
Mailing Address - Country:US
Mailing Address - Phone:626-214-5271
Mailing Address - Fax:
Practice Address - Street 1:538 FRANKLIN PL
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-1519
Practice Address - Country:US
Practice Address - Phone:626-214-5271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT52709106H00000X
CAMFC52709106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist