Provider Demographics
NPI:1790026243
Name:MCINTOSH, MOLLY TERESE (MS, LPC-MH,LAC)
Entity type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:TERESE
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:MS, LPC-MH,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 W 49TH ST
Mailing Address - Street 2:STE 225
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6508
Mailing Address - Country:US
Mailing Address - Phone:605-999-6162
Mailing Address - Fax:605-942-7300
Practice Address - Street 1:2500 W 49TH ST
Practice Address - Street 2:STE 225
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6508
Practice Address - Country:US
Practice Address - Phone:605-999-6162
Practice Address - Fax:605-942-7300
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-08
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD11091485101YA0400X
SDLPC-MH2235101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1790026243Medicaid