Provider Demographics
NPI:1093896847
Name:MACLEAN, MARY ROSE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ROSE
Last Name:MACLEAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4760 FLINTRIDGE DR STE 250
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4264
Mailing Address - Country:US
Mailing Address - Phone:719-260-6262
Mailing Address - Fax:719-260-0780
Practice Address - Street 1:5540 TECH CENTER DR STE 203
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-2330
Practice Address - Country:US
Practice Address - Phone:719-548-0100
Practice Address - Fax:719-548-0616
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1015101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health