Provider Demographics
NPI:1447262118
Name:MCINTOSH, CORRINE BROOK (MFT)
Entity type:Individual
Prefix:
First Name:CORRINE
Middle Name:BROOK
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:CORRINE
Other - Middle Name:MCINTOSH
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFTI
Mailing Address - Street 1:1329 HOWE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-3363
Mailing Address - Country:US
Mailing Address - Phone:916-202-1890
Mailing Address - Fax:916-929-7409
Practice Address - Street 1:1329 HOWE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-3363
Practice Address - Country:US
Practice Address - Phone:916-202-1890
Practice Address - Fax:916-929-7409
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43424106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist