Healthcare Provider Details

I. General information

NPI: 1801937156
Provider Name (Legal Business Name): KAI PATRICK MCBRIDE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E 33RD ST # 201B
VANCOUVER WA
98663-2776
US

IV. Provider business mailing address

91-1841 FORT WEAVER RD
EWA BEACH HI
96706-1909
US

V. Phone/Fax

Practice location:
  • Phone: 360-986-3550
  • Fax:
Mailing address:
  • Phone: 916-835-8836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberLF61066044
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: