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General NPI Number Information
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NPI Number | 1235968579
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Entity Type | Individual
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Provider Name | STEPHANIE MCINTYRE MED, BCBA, LBA
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Gender | Female
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Dates
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Enumeration Date | 07/26/2024
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Last Update Date | 07/26/2024
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Provider Practice Location Address
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Address Line | 105 COLLEGE ST
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City | SOMERSET
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State | KY
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Zip | 42501-1307
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Country | US
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Telephone | 606-677-2636
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Fax |
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Provider Business Mailing Address
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Address Line | 14544 ENGLISH PARK CIR UNIT 102
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City | LOUISVILLE
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State | KY
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Zip | 40299-6481
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Country | US
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Telephone | 321-961-1162
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 290501
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License Number State | KY
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