MEDICARE: MRS. HEIDI JO MCINTIRE M.S., ED.S

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		IN

General Provider Information

NPI Number	:	1952551277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEIDI JO MCINTIRE M.S., ED.S

Provider Business Mailing Address
First Line	:	5735 N DELAWARE ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-2527
Country	:	US
Telephone Number	:	513-304-5587
Fax Number	:

Provider Business Practice Location Address
First Line	:	1308 PROSPECT ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-1939
Country	:	US
Telephone Number	:	317-633-4666
Fax Number	:

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

Provider Enumeration Date	:	09/23/2008
Last Update Date	:	09/23/2008

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