Provider Demographics
NPI:1811288624
Name:MCINTYRE, GARY LEE (MA SCHOOL PSYCHOLO)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:LEE
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:MA SCHOOL PSYCHOLO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 ANDANTE DR.
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-3836
Mailing Address - Country:US
Mailing Address - Phone:928-607-4772
Mailing Address - Fax:928-282-2021
Practice Address - Street 1:221 BREWER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336
Practice Address - Country:US
Practice Address - Phone:928-204-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2998505103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool