Provider Demographics
NPI:1861970527
Name:MCINTYRE, COURTNEY TAYLOR (MED; BCBA; LBA)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:TAYLOR
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:MED; BCBA; LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10915 TORRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-4116
Mailing Address - Country:US
Mailing Address - Phone:502-876-3965
Mailing Address - Fax:
Practice Address - Street 1:9900 SHELBYVILLE RD STE 11B
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-2965
Practice Address - Country:US
Practice Address - Phone:502-915-8796
Practice Address - Fax:502-805-0765
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY243584103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst