Healthcare Provider Details

I. General information

NPI: 1477163319
Provider Name (Legal Business Name): ACTION POTENTIAL BEHAVIORAL HEALTH AND SPORT PSYCHOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 02/25/2023
Certification Date: 02/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 ELM AVE
GRAND JUNCTION CO
81501-2127
US

IV. Provider business mailing address

181 ELM AVE
GRAND JUNCTION CO
81501-2127
US

V. Phone/Fax

Practice location:
  • Phone: 970-609-9810
  • Fax:
Mailing address:
  • Phone: 970-609-9810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. MAE MACINTIRE
Title or Position: OWNER/ PSYCHOLOGIST
Credential: PHD
Phone: 970-609-9810