MEDICARE: KELLY G MCBRIDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	12206	TX

General Provider Information

NPI Number	:	1811750409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY G MCBRIDE

Provider Business Mailing Address
First Line	:	2139 WOODSTON DR
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-2222
Country	:	US
Telephone Number	:	512-431-7357
Fax Number	:

Provider Business Practice Location Address
First Line	:	2139 WOODSTON DR
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-2222
Country	:	US
Telephone Number	:	512-431-7357
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2024
Last Update Date	:	02/05/2024

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Directions to “ KELLY G MCBRIDE ” Practice Location

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