Provider Demographics
NPI:1184769648
Name:MCINTIRE, TINA BETH (MA)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:BETH
Last Name:MCINTIRE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 862
Mailing Address - Street 2:
Mailing Address - City:PINE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91962-0862
Mailing Address - Country:US
Mailing Address - Phone:619-322-7776
Mailing Address - Fax:
Practice Address - Street 1:9905 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-4318
Practice Address - Country:US
Practice Address - Phone:619-333-9003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CALADAC LR 160 112101YA0400X
CACADAC II A677011101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)