Provider Demographics
NPI:1730705971
Name:KINTNER, ALICE ELIZABETH (QMHP)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:ELIZABETH
Last Name:KINTNER
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:ELIZABETH
Other - Last Name:LEACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1515 LIBERTY ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4345
Mailing Address - Country:US
Mailing Address - Phone:503-951-6280
Mailing Address - Fax:503-468-3130
Practice Address - Street 1:1515 LIBERTY ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4345
Practice Address - Country:US
Practice Address - Phone:503-951-6280
Practice Address - Fax:503-468-3130
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health