Provider Demographics
NPI:1659795987
Name:MCINTYRE, SUSAN (LMFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CENTER CT
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-5708
Mailing Address - Country:US
Mailing Address - Phone:714-305-2338
Mailing Address - Fax:
Practice Address - Street 1:7700 IRVINE CENTER DR
Practice Address - Street 2:SUITE 800
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2923
Practice Address - Country:US
Practice Address - Phone:714-305-2338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2015-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA89894OtherBOARD OF BEHAVIORAL SCIENCE