Provider Demographics
NPI:1457372914
Name:MCINTYRE, RAYMOND EDWARD (MFT)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:EDWARD
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9905 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-4318
Mailing Address - Country:US
Mailing Address - Phone:619-449-9937
Mailing Address - Fax:619-449-1401
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:619-449-9937
Practice Address - Fax:619-449-1401
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 9417106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist