Provider Demographics
NPI:1538133756
Name:MCEWEN, MICHAEL THOMAS (DMIN, LADC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:MCEWEN
Suffix:
Gender:M
Credentials:DMIN, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 PACIFIC HILLS PT
Mailing Address - Street 2:A-201
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-8405
Mailing Address - Country:US
Mailing Address - Phone:719-576-3860
Mailing Address - Fax:
Practice Address - Street 1:910 PACIFIC HILLS PT
Practice Address - Street 2:A-201
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-8405
Practice Address - Country:US
Practice Address - Phone:719-576-3860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK53101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)