Provider Demographics
NPI:1760874580
Name:DR. DAVID MACINTYRE CONSULTING, LLC
Entity Type:Organization
Organization Name:DR. DAVID MACINTYRE CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:MACINTYRE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:715-298-2846
Mailing Address - Street 1:2405 SCHOFIELD AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-2300
Mailing Address - Country:US
Mailing Address - Phone:715-298-2846
Mailing Address - Fax:715-298-3146
Practice Address - Street 1:2405 SCHOFIELD AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-2300
Practice Address - Country:US
Practice Address - Phone:715-298-2846
Practice Address - Fax:715-298-3146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-03
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.003018101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty