Provider Demographics
NPI:1821207630
Name:MCINTYRE, ROBERT K (LLP NCC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:K
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:LLP NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7889 RED ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127
Mailing Address - Country:US
Mailing Address - Phone:269-465-4000
Mailing Address - Fax:269-465-4001
Practice Address - Street 1:7889 RED ARROW HWY
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127
Practice Address - Country:US
Practice Address - Phone:269-465-4000
Practice Address - Fax:269-465-4001
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010904103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling