Healthcare Provider Details

I. General information

NPI: 1346334810
Provider Name (Legal Business Name): DONALD HARRY MCINTIRE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 EXECUTIVE DR SUITE 201
MARION OH
43302-6285
US

IV. Provider business mailing address

125 EXECUTIVE DR STE 201
MARION OH
43302-6302
US

V. Phone/Fax

Practice location:
  • Phone: 740-387-3087
  • Fax: 740-382-5034
Mailing address:
  • Phone: 419-562-2000
  • Fax: 419-562-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4545
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: