Provider Demographics
NPI:1053149013
Name:MCINTYRE, ASHLYNN PAIGE
Entity type:Individual
Prefix:
First Name:ASHLYNN
Middle Name:PAIGE
Last Name:MCINTYRE
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 1:4007 W RICHMOND SHOP RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37090-0891
Mailing Address - Country:US
Mailing Address - Phone:618-604-9138
Mailing Address - Fax:
Practice Address - Street 1:739 PRESIDENT PL STE 110
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6845
Practice Address - Country:US
Practice Address - Phone:615-625-5855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician