Provider Demographics
NPI:1679763775
Name:MCINTYRE, JEFF (MS COUNSELOR, LPC)
Entity Type:Individual
Prefix:MR
First Name:JEFF
Middle Name:
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:MS COUNSELOR, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4884
Mailing Address - Street 2:
Mailing Address - City:PAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:86040-4884
Mailing Address - Country:US
Mailing Address - Phone:928-660-0256
Mailing Address - Fax:
Practice Address - Street 1:32 N. 10TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PAGE
Practice Address - State:AZ
Practice Address - Zip Code:86040-4884
Practice Address - Country:US
Practice Address - Phone:928-660-0256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-12648101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health