Provider Demographics
NPI:1154524296
Name:MCBRIDE, TANYA GAYLE (LPCC, LADAC)
Entity type:Individual
Prefix:MS
First Name:TANYA
Middle Name:GAYLE
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:LPCC, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 CAGUA DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1825
Mailing Address - Country:US
Mailing Address - Phone:505-238-7830
Mailing Address - Fax:
Practice Address - Street 1:2600 MARBLE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1315
Practice Address - Country:US
Practice Address - Phone:505-272-6648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0096341101Y00000X
NM0084871101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor