Healthcare Provider Details

I. General information

NPI: 1649555152
Provider Name (Legal Business Name): MARY ANN MCCAIN LPC, CAC III
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2011
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 ELKTON DR STE 300
COLORADO SPRINGS CO
80907-3597
US

IV. Provider business mailing address

1115 ELKTON DR STE 300
COLORADO SPRINGS CO
80907-3597
US

V. Phone/Fax

Practice location:
  • Phone: 719-373-9703
  • Fax: 877-588-3465
Mailing address:
  • Phone: 719-373-9703
  • Fax: 877-588-3465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4932
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6353
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: