MEDICARE: MR. GALEN MCINTOSH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	252662	KY
2	1041C0700X	Clinical Social Worker	252662	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417473158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GALEN MCINTOSH

Provider Business Mailing Address
First Line	:	1229 COLORADO RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-2397
Country	:	US
Telephone Number	:	859-888-0262
Fax Number	:

Provider Business Practice Location Address
First Line	:	1229 COLORADO RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-2397
Country	:	US
Telephone Number	:	859-888-0262
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2017
Last Update Date	:	12/30/2021

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Directions to “ MR. GALEN MCINTOSH ” Practice Location

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