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General NPI Number Information
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NPI Number | 1912358649
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Entity Type | Individual
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Provider Name | DAVID JOHN MCINTYRE MSW, LCSW
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Gender | Male
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Dates
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Enumeration Date | 06/23/2016
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Last Update Date | 08/21/2019
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Provider Practice Location Address
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Address Line | 1450 BIRCH AVE
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City | COTTAGE GROVE
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State | OR
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Zip | 97424-1417
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Country | US
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Telephone | 541-606-2124
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Fax | 360-844-5184
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Provider Business Mailing Address
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Address Line | 2727 GATEWAY ST APT 27
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City | SPRINGFIELD
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State | OR
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Zip | 97477-1126
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Country | US
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Telephone | 541-606-2124
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Fax | 360-844-5184
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L7847
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License Number State | OR
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