MEDICARE: MRS. MARY ROSE MACLEAN LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	1015	CO

General Provider Information

NPI Number	:	1093896847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY ROSE MACLEAN LPC

Provider Business Mailing Address
First Line	:	4760 FLINTRIDGE DR STE 250
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-4264
Country	:	US
Telephone Number	:	719-260-6262
Fax Number	:	719-260-0780

Provider Business Practice Location Address
First Line	:	5540 TECH CENTER DR STE 203
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-2330
Country	:	US
Telephone Number	:	719-548-0100
Fax Number	:	719-548-0616

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	03/03/2008

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