1063832707 NPI number — LEAH MCINTIRE, MA, LPC

Table of content: (NPI 1063832707)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063832707 NPI number — LEAH MCINTIRE, MA, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEAH MCINTIRE, MA, LPC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063832707
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5000 GREENBAG RD
Provider Second Line Business Mailing Address:
SUITE M4
Provider Business Mailing Address City Name:
MORGANTOWN
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26501-7163
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-241-4123
Provider Business Mailing Address Fax Number:
304-381-4447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5000 GREENBAG RD
Provider Second Line Business Practice Location Address:
SUITE M4
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26501-7163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-241-4123
Provider Business Practice Location Address Fax Number:
304-381-4447
Provider Enumeration Date:
04/21/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MCINTIRE
Authorized Official First Name:
LEAH
Authorized Official Middle Name:
K
Authorized Official Title or Position:
LICENSED COUNSELOR
Authorized Official Telephone Number:
304-241-4123

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  2014 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1588090385 . This is a "NPI" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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