Basic Information
| Provider Information | |||||||||
| NPI: | 1528303583 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCINTIRE | ||||||||
| FirstName: | MATT | ||||||||
| MiddleName: | |||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 427 ALA MAKANI ST # 201 | ||||||||
| Address2: | |||||||||
| City: | KAHULUI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967323507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082446879 | ||||||||
| FaxNumber: | 8088730272 | ||||||||
| Practice Location | |||||||||
| Address1: | 427 ALA MAKANI ST # 201 | ||||||||
| Address2: | |||||||||
| City: | KAHULUI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967323507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082446879 | ||||||||
| FaxNumber: | 8088730272 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2012 | ||||||||
| LastUpdateDate: | 11/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-17-25047 | HI | Y | Behavioral Health & Social Service Providers | Behavioral Analyst | 103K00000X | BCABA: 0-10-3947 | CA | N | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.