Provider Demographics
NPI:1770143182
Name:CULLINANE, BRIAN PATRICK (LPC, LAC, MAC, ATR)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:PATRICK
Last Name:CULLINANE
Suffix:
Gender:M
Credentials:LPC, LAC, MAC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5103 WILLIAMS FORK TRL APT 202
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3422
Mailing Address - Country:US
Mailing Address - Phone:732-239-5818
Mailing Address - Fax:
Practice Address - Street 1:5103 WILLIAMS FORK TRL APT 202
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3422
Practice Address - Country:US
Practice Address - Phone:732-239-5818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0002224101YA0400X
COLPC.0019701101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
COACD.0002224OtherDEPARTMENT OF REGULATORY AGENCIES
COLPC.0019701OtherDEPARTMENT OF REGULATORY AGENCIES