Provider Demographics
NPI:1417263831
Name:MCBRIDE, KIMBERLEY LESA (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:LESA
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 WESTLAKE AVE N
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-5802
Mailing Address - Country:US
Mailing Address - Phone:206-898-8450
Mailing Address - Fax:206-260-1437
Practice Address - Street 1:2100 WESTLAKE AVE N
Practice Address - Street 2:SUITE 201
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-5802
Practice Address - Country:US
Practice Address - Phone:206-898-8450
Practice Address - Fax:206-260-1437
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2012-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60090294106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist