Provider Demographics
NPI:1710433735
Name:MARY MACLEAN, MA, LPC, P.C.
Entity Type:Organization
Organization Name:MARY MACLEAN, MA, LPC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MACLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:719-260-6262
Mailing Address - Street 1:108 E SAINT VRAIN ST
Mailing Address - Street 2:STE. 11
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1117
Mailing Address - Country:US
Mailing Address - Phone:719-260-6262
Mailing Address - Fax:719-260-0780
Practice Address - Street 1:108 E SAINT VRAIN ST
Practice Address - Street 2:STE. 11
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1117
Practice Address - Country:US
Practice Address - Phone:719-260-6262
Practice Address - Fax:719-260-0780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0001015101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty