Provider Demographics
NPI:1336362110
Name:MCINTYRE, ELIZABETH WOLFF (MSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:WOLFF
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:LIBBY
Other - Middle Name:
Other - Last Name:MCINTYRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 1494
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806-1494
Mailing Address - Country:US
Mailing Address - Phone:406-541-0202
Mailing Address - Fax:406-541-0203
Practice Address - Street 1:700 SOUTH AVE W
Practice Address - Street 2:SUITE B
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8000
Practice Address - Country:US
Practice Address - Phone:406-541-0202
Practice Address - Fax:406-541-0203
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT476-LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000502282Medicaid