Provider Demographics
NPI:1770298663
Name:MCBRIDE, JENNIFER M (LMSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 S PIN OAK
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-8057
Mailing Address - Country:US
Mailing Address - Phone:417-718-6822
Mailing Address - Fax:
Practice Address - Street 1:219 W COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-2647
Practice Address - Country:US
Practice Address - Phone:417-718-6822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20220445541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2022044554OtherMISSOURI BOARD OF SOCIAL WORKERS