Provider Demographics
NPI:1407578800
Name:MACINTYRE, CARSON DOUGLAS (MS, LCPC)
Entity type:Individual
Prefix:
First Name:CARSON
Middle Name:DOUGLAS
Last Name:MACINTYRE
Suffix:
Gender:M
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 GARFIELD ST SE
Mailing Address - Street 2:
Mailing Address - City:RONAN
Mailing Address - State:MT
Mailing Address - Zip Code:59864-3316
Mailing Address - Country:US
Mailing Address - Phone:320-318-3811
Mailing Address - Fax:
Practice Address - Street 1:123 GARFIELD ST SE
Practice Address - Street 2:
Practice Address - City:RONAN
Practice Address - State:MT
Practice Address - Zip Code:59864-3316
Practice Address - Country:US
Practice Address - Phone:320-318-3811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK196757101YP2500X
MTBBH-LCPC-LIC-55522101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional