Provider Demographics
NPI:1649584640
Name:MCINTYRE, LEA A (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:A
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7410 BLANCO RD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-4363
Mailing Address - Country:US
Mailing Address - Phone:210-526-1691
Mailing Address - Fax:210-714-0169
Practice Address - Street 1:15150 BLANCO RD
Practice Address - Street 2:#1206
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-3308
Practice Address - Country:US
Practice Address - Phone:210-723-6536
Practice Address - Fax:210-714-0169
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64743101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
2137325-08OtherCSHCS MEDICAID
TX2137325-07Medicaid