Provider Demographics
NPI:1144507989
Name:MCINTYRE, MARY JEAN (LPC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JEAN
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 N BROADVIEW ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-4313
Mailing Address - Country:US
Mailing Address - Phone:573-334-2889
Mailing Address - Fax:573-651-9152
Practice Address - Street 1:615 N BROADVIEW ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4313
Practice Address - Country:US
Practice Address - Phone:573-334-2889
Practice Address - Fax:573-651-9152
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000845101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health