Provider Demographics
NPI:1699789404
Name:MCINTEE, BETTY WARREN
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:WARREN
Last Name:MCINTEE
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 1:225 W BRECKINRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-2219
Mailing Address - Country:US
Mailing Address - Phone:502-637-4361
Mailing Address - Fax:502-587-7145
Practice Address - Street 1:225 W BRECKINRIDGE ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2219
Practice Address - Country:US
Practice Address - Phone:502-637-4361
Practice Address - Fax:502-587-7145
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0046713Medicare ID - Type Unspecified