Provider Demographics
NPI:1730279134
Name:MCBRIDE, JEFFREY W (MSW)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:W
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 HOLLOW RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HYRUM
Mailing Address - State:UT
Mailing Address - Zip Code:84319-1500
Mailing Address - Country:US
Mailing Address - Phone:435-245-6148
Mailing Address - Fax:
Practice Address - Street 1:175 W 1400 N
Practice Address - Street 2:STE A LDS FAMILY SERVICES
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341
Practice Address - Country:US
Practice Address - Phone:435-752-5302
Practice Address - Fax:435-753-9007
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1091573902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist