Provider Demographics
NPI:1215283007
Name:MCINTYRE, WADE (LPC-MH)
Entity type:Individual
Prefix:
First Name:WADE
Middle Name:
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:LPC-MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-0304
Mailing Address - Country:US
Mailing Address - Phone:605-310-8485
Mailing Address - Fax:
Practice Address - Street 1:1921 W 18TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0304
Practice Address - Country:US
Practice Address - Phone:605-310-8485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPCMH2219101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health