Provider Demographics
NPI:1619294733
Name:MCBRIDE, ELIS LASHAN (MS)
Entity Type:Individual
Prefix:
First Name:ELIS
Middle Name:LASHAN
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 WYATT EARP LOOP
Mailing Address - Street 2:
Mailing Address - City:NOLANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76559-9752
Mailing Address - Country:US
Mailing Address - Phone:254-833-4992
Mailing Address - Fax:
Practice Address - Street 1:147 WYATT EARP LOOP
Practice Address - Street 2:
Practice Address - City:NOLANVILLE
Practice Address - State:TX
Practice Address - Zip Code:76559-9752
Practice Address - Country:US
Practice Address - Phone:254-833-4992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178005212101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor