Provider Demographics
NPI:1386933067
Name:MCINTIRE, TARA (RRW)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:MCINTIRE
Suffix:
Gender:F
Credentials:RRW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 HENDERSON ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-7374
Mailing Address - Country:US
Mailing Address - Phone:530-273-9541
Mailing Address - Fax:530-273-7740
Practice Address - Street 1:440 HENDERSON ST
Practice Address - Street 2:SUITE C
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-7374
Practice Address - Country:US
Practice Address - Phone:530-273-9541
Practice Address - Fax:530-273-7740
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)