Provider Demographics
NPI:1689008021
Name:MACKINTOSH, BARBARA L (LAMFT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:L
Last Name:MACKINTOSH
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10505 WAYZATA BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1502
Mailing Address - Country:US
Mailing Address - Phone:612-618-2205
Mailing Address - Fax:
Practice Address - Street 1:10505 WAYZATA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1502
Practice Address - Country:US
Practice Address - Phone:612-618-2205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2734106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist