Provider Demographics
NPI:1700926045
Name:MCINTOSH, JUDITH JODI (MFT)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:JODI
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:MARIE
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:187 GALLOWAY DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-2052
Mailing Address - Country:US
Mailing Address - Phone:503-894-3556
Mailing Address - Fax:
Practice Address - Street 1:187 GALLOWAY DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-2052
Practice Address - Country:US
Practice Address - Phone:503-894-3556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42850106H00000X
CA42850106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist