Provider Demographics
NPI:1124605860
Name:PAQUETTE MCBRIDE, KRYSTAL RAE LYNN (MAS, LMFT)
Entity type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:RAE LYNN
Last Name:PAQUETTE MCBRIDE
Suffix:
Gender:F
Credentials:MAS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4539 N 22ND ST STE 105
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4637
Mailing Address - Country:US
Mailing Address - Phone:480-535-1302
Mailing Address - Fax:
Practice Address - Street 1:4539 N 22ND ST STE 105
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4637
Practice Address - Country:US
Practice Address - Phone:513-850-2782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-27
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-15962106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist