Provider Demographics
NPI:1578812541
Name:MCBRIDE, ELIZABETH ODOM (MS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ODOM
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:MCBRIDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:1424 HEMPHILL ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4443 N JOSEY LN
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4743
Practice Address - Country:US
Practice Address - Phone:817-759-7913
Practice Address - Fax:817-303-9274
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108203235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist