Provider Demographics
NPI:1346206281
Name:MCBRIDE, ELLEN (MA)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1062 MAPLE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2815
Mailing Address - Country:US
Mailing Address - Phone:304-599-5751
Mailing Address - Fax:304-599-2124
Practice Address - Street 1:1062 MAPLE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2815
Practice Address - Country:US
Practice Address - Phone:304-599-5751
Practice Address - Fax:304-599-2124
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1383101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV463109OtherVALUE OPTIONS