Healthcare Provider Details

I. General information

NPI: 1285728642
Provider Name (Legal Business Name): BRIAN W. MCLEARY LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 EISENHOWER BLVD STE 204
JOHNSTOWN PA
15904-3338
US

IV. Provider business mailing address

1360 EISENHOWER BLVD STE 204
JOHNSTOWN PA
15904-3338
US

V. Phone/Fax

Practice location:
  • Phone: 814-241-8757
  • Fax: 814-241-8757
Mailing address:
  • Phone: 814-241-8757
  • Fax: 814-241-8757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPC003641
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC003641
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC003641
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: