1417263831 NPI number — KIMBERLEY LESA MCBRIDE MA, LMFT

Table of content: KIMBERLEY LESA MCBRIDE MA, LMFT (NPI 1417263831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417263831 NPI number — KIMBERLEY LESA MCBRIDE MA, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCBRIDE
Provider First Name:
KIMBERLEY
Provider Middle Name:
LESA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417263831
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2100 WESTLAKE AVE N
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98109-5802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-898-8450
Provider Business Mailing Address Fax Number:
206-260-1437

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 WESTLAKE AVE N
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98109-5802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-898-8450
Provider Business Practice Location Address Fax Number:
206-260-1437
Provider Enumeration Date:
08/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  LF60090294 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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