Healthcare Provider Details

I. General information

NPI: 1457152407
Provider Name (Legal Business Name): JOSHUA MCBRIDE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1159 E IRON EAGLE DR STE 170I
EAGLE ID
83616-6871
US

IV. Provider business mailing address

254 S POPLAR BLUFF AVE
EAGLE ID
83616-5034
US

V. Phone/Fax

Practice location:
  • Phone: 208-515-2189
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number8481513
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: