Healthcare Provider Details

I. General information

NPI: 1710950316
Provider Name (Legal Business Name): MARION KAY MCINTYRE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9060 WATSON RD STE E
CRESTWOOD MO
63126
US

IV. Provider business mailing address

9060 WATSON RD STE E
CRESTWOOD MO
63126
US

V. Phone/Fax

Practice location:
  • Phone: 314-729-1062
  • Fax:
Mailing address:
  • Phone: 314-729-1062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY01328
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: