Provider Demographics
NPI:1982405445
Name:MCBRIDE, KELLY (MA, LPC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MCBRIDE
Suffix:
Gender:
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8150 WHITBURN DR APT 1W
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-2446
Mailing Address - Country:US
Mailing Address - Phone:314-600-8733
Mailing Address - Fax:
Practice Address - Street 1:8150 WHITBURN DR APT 1W
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-2446
Practice Address - Country:US
Practice Address - Phone:314-600-8733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015030360101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health