MEDICARE: MS. TANYA MCINTYRE LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	18683	FL

General Provider Information

NPI Number	:	1700474707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TANYA MCINTYRE LMHC

Provider Business Mailing Address
First Line	:	1010 N 12TH AVE STE 324
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32501-3492
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 N 12TH AVE STE 324
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32501-3492
Country	:	US
Telephone Number	:	850-359-2925
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2021
Last Update Date	:	01/05/2021

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