Healthcare Provider Details

I. General information

NPI: 1184094161
Provider Name (Legal Business Name): MAGAYLA DANIELLE MCBRIDE MHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2015
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 EE WALLACE BLVD S
FERRIDAY LA
71334-3224
US

IV. Provider business mailing address

615 EE WALLACE BLVD S
FERRIDAY LA
71334-3224
US

V. Phone/Fax

Practice location:
  • Phone: 318-757-9363
  • Fax:
Mailing address:
  • Phone: 318-757-9363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPLC9947
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC9947
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: