Provider Demographics
NPI:1336365717
Name:MCBRIDE PSYCHOLOGCIAL SERVICES, P.S.
Entity Type:Organization
Organization Name:MCBRIDE PSYCHOLOGCIAL SERVICES, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:360-683-6513
Mailing Address - Street 1:9732 OLD OLYMPIC HWY
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3150
Mailing Address - Country:US
Mailing Address - Phone:360-683-6513
Mailing Address - Fax:360-683-6619
Practice Address - Street 1:9732 OLD OLYMPIC HWY
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3150
Practice Address - Country:US
Practice Address - Phone:360-683-6513
Practice Address - Fax:360-683-6619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001195103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty