Provider Demographics
NPI:1881724748
Name:MCINTIRE, TERESA (MA)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:MCINTIRE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3191 CHURN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-2123
Mailing Address - Country:US
Mailing Address - Phone:530-224-7160
Mailing Address - Fax:530-224-7168
Practice Address - Street 1:3191 CHURN CREEK RD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2123
Practice Address - Country:US
Practice Address - Phone:530-224-7160
Practice Address - Fax:530-224-7168
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 50383101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor