Provider Demographics
NPI:1457177636
Name:MCINTYRE, WILLIAM JOHN
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOHN
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10510 JOOR RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70818-3900
Mailing Address - Country:US
Mailing Address - Phone:225-960-2403
Mailing Address - Fax:225-256-1707
Practice Address - Street 1:10510 JOOR RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70818-3900
Practice Address - Country:US
Practice Address - Phone:225-960-2403
Practice Address - Fax:225-256-1707
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician