1295176634 NPI number — MRS. BROOKE J MCINTYRE MA, LMHC

Table of content: MRS. BROOKE J MCINTYRE MA, LMHC (NPI 1295176634)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295176634 NPI number — MRS. BROOKE J MCINTYRE MA, LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCINTYRE
Provider First Name:
BROOKE
Provider Middle Name:
J
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAGRO
Provider Other First Name:
BROOKE
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, LMHC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295176634
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
240 N TILLOTSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUNCIE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47304-3988
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-288-1928
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1818 WENT AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISHAWAKA
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46545-6482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-254-0229
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  39002735A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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