Provider Demographics
NPI:1972277002
Name:MCBRIDE, ANDREW (LPC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29038 N CARNELIAN DR
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-6269
Mailing Address - Country:US
Mailing Address - Phone:602-755-2384
Mailing Address - Fax:
Practice Address - Street 1:29038 N CARNELIAN DR
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-6269
Practice Address - Country:US
Practice Address - Phone:602-755-2384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-19481101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPC-19481OtherARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS