Provider Demographics
NPI:1912358649
Name:MCINTYRE, DAVID JOHN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 GATEWAY ST
Mailing Address - Street 2:APT 27
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-1126
Mailing Address - Country:US
Mailing Address - Phone:541-606-2124
Mailing Address - Fax:360-844-5184
Practice Address - Street 1:1450 BIRCH AVE
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-1417
Practice Address - Country:US
Practice Address - Phone:541-606-2124
Practice Address - Fax:360-844-5184
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL78471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical