Provider Demographics
NPI:1215105861
Name:MACKILLOP, DEBRA JEAN
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:JEAN
Last Name:MACKILLOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7878 WADSWORTH BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-2146
Mailing Address - Country:US
Mailing Address - Phone:303-425-0300
Mailing Address - Fax:303-432-5790
Practice Address - Street 1:7878 WADSWORTH BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-2146
Practice Address - Country:US
Practice Address - Phone:303-425-0300
Practice Address - Fax:303-432-5790
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health