Provider Demographics
NPI:1952551277
Name:MCINTIRE, HEIDI JO (MS, EDS)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:JO
Last Name:MCINTIRE
Suffix:
Gender:F
Credentials:MS, EDS
Other - Prefix:MS
Other - First Name:HEIDI
Other - Middle Name:JO
Other - Last Name:KUEBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, EDS
Mailing Address - Street 1:5735 N DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2527
Mailing Address - Country:US
Mailing Address - Phone:513-304-5587
Mailing Address - Fax:
Practice Address - Street 1:1308 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-1939
Practice Address - Country:US
Practice Address - Phone:317-633-4666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health