Provider Demographics
NPI:1205167020
Name:MCBRIDE, TINA (LPC, U/S)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:LPC, U/S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 SE 1170TH AVE
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:OK
Mailing Address - Zip Code:74563-2352
Mailing Address - Country:US
Mailing Address - Phone:918-753-2407
Mailing Address - Fax:
Practice Address - Street 1:133 SE 1170TH AVE
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:OK
Practice Address - Zip Code:74563-2352
Practice Address - Country:US
Practice Address - Phone:918-753-2407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-18
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103TR0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation