Provider Demographics
NPI:1780656918
Name:MCINTIRE, LINDA (HSPP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MCINTIRE
Suffix:
Gender:F
Credentials:HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-1201
Mailing Address - Country:US
Mailing Address - Phone:317-398-7211
Mailing Address - Fax:317-398-7210
Practice Address - Street 1:149 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-1201
Practice Address - Country:US
Practice Address - Phone:317-298-7211
Practice Address - Fax:317-398-7210
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042156A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000321009OtherANTHEM PIN
IN000000321009OtherANTHEM PIN