Provider Demographics
NPI:1740699594
Name:MCINTOSH, JOYCE
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:C
Other - Last Name:MCINTOSH-THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5100 N 6TH ST STE 142
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7514
Mailing Address - Country:US
Mailing Address - Phone:559-270-0178
Mailing Address - Fax:
Practice Address - Street 1:730 W. INDIANAPOLIS AVE.
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93705-1018
Practice Address - Country:US
Practice Address - Phone:559-270-0178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA263151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical