Healthcare Provider Details

I. General information

NPI: 1952551277
Provider Name (Legal Business Name): HEIDI JO MCINTIRE M.S., ED.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEIDI JO KUEBEL M.S, ED.S

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 PROSPECT ST
INDIANAPOLIS IN
46203-1939
US

IV. Provider business mailing address

5735 N DELAWARE ST
INDIANAPOLIS IN
46220-2527
US

V. Phone/Fax

Practice location:
  • Phone: 317-633-4666
  • Fax:
Mailing address:
  • Phone: 513-304-5587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: