Provider Demographics
NPI:1669166377
Name:MCINTOSH, BRANDY LYNN
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:LYNN
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9804
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-9804
Mailing Address - Country:US
Mailing Address - Phone:308-398-5427
Mailing Address - Fax:308-398-5404
Practice Address - Street 1:2112 W FAIDLEY AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4670
Practice Address - Country:US
Practice Address - Phone:308-398-5427
Practice Address - Fax:308-398-5427
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)