Provider Demographics
NPI:1295921179
Name:MCBRIDE, NANCY JO (PHD, ABSNP, NCSP)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:JO
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:PHD, ABSNP, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 E BRADFORD PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4264
Mailing Address - Country:US
Mailing Address - Phone:417-761-5000
Mailing Address - Fax:417-761-5011
Practice Address - Street 1:SPRINGFIELD PUBLIC SCHOOLS
Practice Address - Street 2:1610 E. SUNSHINE ST.
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804
Practice Address - Country:US
Practice Address - Phone:417-881-1810
Practice Address - Fax:417-881-1866
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TB0200X, 103TM1800X, 103TS0200X
MO103TM1800X, 103TS0200X
MO2018034596101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO14410077OtherCAQH