Provider Demographics
NPI:1669797452
Name:MCBRIDE, TRAVIS MICHAEL (LMHC)
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:MICHAEL
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3146 DEER TRL
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-1448
Mailing Address - Country:US
Mailing Address - Phone:386-747-6848
Mailing Address - Fax:386-736-9181
Practice Address - Street 1:125 W PLYMOUTH AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-2745
Practice Address - Country:US
Practice Address - Phone:386-736-9165
Practice Address - Fax:386-736-9181
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10233101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health