Provider Demographics
NPI:1811231293
Name:MCBRIDE, COLLEEN (LMFT139089)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:LMFT139089
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 PALOMAR AIRPORT RD STE 225
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1049
Mailing Address - Country:US
Mailing Address - Phone:858-731-6148
Mailing Address - Fax:
Practice Address - Street 1:703 PALOMAR AIRPORT RD STE 225
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1049
Practice Address - Country:US
Practice Address - Phone:858-731-6148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2023-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA139089106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program