Provider Demographics
NPI:1811122443
Name:MACLEAN, KIRK PAUL SR (CI)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:PAUL
Last Name:MACLEAN
Suffix:SR
Gender:M
Credentials:CI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3819 HWY 34 S
Mailing Address - Street 2:SUITE C
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-5136
Mailing Address - Country:US
Mailing Address - Phone:903-883-4500
Mailing Address - Fax:903-883-4510
Practice Address - Street 1:3819 HWY 34 S
Practice Address - Street 2:SUITE C
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-5136
Practice Address - Country:US
Practice Address - Phone:903-883-4500
Practice Address - Fax:903-883-4510
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5747101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)