Provider Demographics
NPI:1295372886
Name:MCBRIDE, STEPHANIE (CADC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 N 7TH AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-5788
Mailing Address - Country:US
Mailing Address - Phone:208-242-8249
Mailing Address - Fax:208-242-9115
Practice Address - Street 1:1001 N 7TH AVE STE 260
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5788
Practice Address - Country:US
Practice Address - Phone:208-242-8249
Practice Address - Fax:208-242-9115
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID101Y00000XOtherTAXONOMY