Provider Demographics
NPI:1770835910
Name:MACILWINEN, GEORGE RANKIN (MA, LPC, CAC I)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:RANKIN
Last Name:MACILWINEN
Suffix:
Gender:M
Credentials:MA, LPC, CAC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2769 IRIS AVE. STE 114
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-0679
Mailing Address - Country:US
Mailing Address - Phone:720-432-3147
Mailing Address - Fax:
Practice Address - Street 1:2769 IRIS AVE STE 114
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-4405
Practice Address - Country:US
Practice Address - Phone:720-432-3147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13670101Y00000X
CO6941101YA0400X
CO12353101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)