Provider Demographics
NPI:1659821015
Name:MCBRIDE, BRITTNEY DEANA PAIGE (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:BRITTNEY
Middle Name:DEANA PAIGE
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 N IL RT 3
Mailing Address - Street 2:BOX 243
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-1899
Mailing Address - Country:US
Mailing Address - Phone:618-340-5986
Mailing Address - Fax:618-340-5986
Practice Address - Street 1:5917 WILLOW OAK DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-3075
Practice Address - Country:US
Practice Address - Phone:618-340-5986
Practice Address - Fax:618-340-5986
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178012022101YP2500X
IL180010599101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional