Provider Demographics
NPI:1548575616
Name:MCINTOSH-KASBAR, MIESHA (LMHC, MCAP)
Entity type:Individual
Prefix:MRS
First Name:MIESHA
Middle Name:
Last Name:MCINTOSH-KASBAR
Suffix:
Gender:F
Credentials:LMHC, MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 COLORADO AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2103
Mailing Address - Country:US
Mailing Address - Phone:954-245-1819
Mailing Address - Fax:772-444-3395
Practice Address - Street 1:300 COLORADO AVE STE 208
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994
Practice Address - Country:US
Practice Address - Phone:954-245-1819
Practice Address - Fax:772-444-3395
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X
FLMH10107101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health