Provider Demographics
NPI:1407249907
Name:MCBRAIN, PHILIP KEITH (LPC, ADDC)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:KEITH
Last Name:MCBRAIN
Suffix:
Gender:M
Credentials:LPC, ADDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 ONEAL PKWY APT V31
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1490
Mailing Address - Country:US
Mailing Address - Phone:646-549-1825
Mailing Address - Fax:
Practice Address - Street 1:100 ARAPAHOE AVE STE 12
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5862
Practice Address - Country:US
Practice Address - Phone:720-445-9890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0014828101YM0800X
COADDC.0000015101YM0800X
COLPC.0016946101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health