Healthcare Provider Details

I. General information

NPI: 1477623270
Provider Name (Legal Business Name): MICHAEL VERNON MCENTIRE II LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 W AERO DR
PAYSON AZ
85541-5407
US

IV. Provider business mailing address

418 N BRIARWOOD RD
PAYSON AZ
85541-4103
US

V. Phone/Fax

Practice location:
  • Phone: 928-474-3303
  • Fax:
Mailing address:
  • Phone: 480-825-8758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC24138
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD5674
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: