Provider Demographics
NPI:1629078340
Name:MCINTOSH, ALKA ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:ALKA
Middle Name:ANNE
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 BERRYWOOD DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6500
Mailing Address - Country:US
Mailing Address - Phone:573-443-1177
Mailing Address - Fax:573-499-1564
Practice Address - Street 1:3407 BERRYWOOD DR
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6500
Practice Address - Country:US
Practice Address - Phone:573-443-1177
Practice Address - Fax:573-499-1564
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW002402104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6205684OtherUNITED BEHAVIORAL HEALTH
MO143173OtherBLUE CROSS BLUE SHIELD