Provider Demographics
NPI:1285728642
Name:MCLEARY, BRIAN W (LPC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:W
Last Name:MCLEARY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 EISENHOWER BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3338
Mailing Address - Country:US
Mailing Address - Phone:814-241-8757
Mailing Address - Fax:814-241-8757
Practice Address - Street 1:1360 EISENHOWER BLVD STE 204
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3338
Practice Address - Country:US
Practice Address - Phone:814-241-8757
Practice Address - Fax:814-241-8757
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003641101YM0800X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026010670001Medicaid