Provider Demographics
NPI:1649280736
Name:MCINTOSH, ANN KATHERINE (LCSW)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:KATHERINE
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:K
Other - Last Name:MCINTOSH, MA, LCSW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:4407 BEE CAVE RD.
Mailing Address - Street 2:BLDG. 5 STE. 513
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6405
Mailing Address - Country:US
Mailing Address - Phone:512-306-9992
Mailing Address - Fax:512-328-3228
Practice Address - Street 1:4407 BEE CAVE RD.
Practice Address - Street 2:BLDG. 5 STE. 513
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6405
Practice Address - Country:US
Practice Address - Phone:512-306-9992
Practice Address - Fax:512-328-3228
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX254801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0070CYOtherCROSS BLUE SHIELD OF TEXA