Provider Demographics
NPI:1770640690
Name:MCINTYRE, JULIE KAY (LPC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:KAY
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:KAY
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:9750 CR 1210
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-8710
Mailing Address - Country:US
Mailing Address - Phone:903-804-7669
Mailing Address - Fax:972-617-0655
Practice Address - Street 1:115 SOUTH PALESTINE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-8710
Practice Address - Country:US
Practice Address - Phone:903-804-7669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPC101YP2500X
TX20152101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179401801Medicaid